Baseline Survey On Child and Related Maternal Health Care-Revised Report - Madhya Pradesh-491 - 1

NIPI Baseline Report – Madhya Pradesh
BASELINE SURVEY ON
CHILD AND RELATED
MATERNAL HEALTH CARE
Revised Report – MADHYA PRADESH
Prepared For:
Norway India Partnership Initiative,
New Delhi
Client Contact:
Mr. P.K. Hota
TNS Consultant:
Sandeep Ghosh
TNS India Private Limited
7th floor, Block 4- B
DLF coporate Park, DLF City
Phase- III, M G Road
Gurgoan 122002
India
e: sandeep.ghosh@tns-global.com
Project No: 193318
August, 2009
CONTENTS
Page No.
Baseline Summary Indicators 1–3
Chapter 1 Introduction 4
1.1 Background of NIPI 4

1.2 Research Objectives 5
1.3 Study Phases 5
1.4 Study Area 5
1.5 Ongoing health related programs in MP 5
1.6 Demographic profile of NIPI states 6
1.6.1 About Madhya Pradesh and NIPI states 6
1.6.2 Profile of Hoshangabad district 8
1.6.3 Profile of Narsimhapur district 10
1.6.4 Profile of Raisen district 12
1.7 Survey Design 13 14
1.7.1 Sampling strategy at district level 14
1.8 Quantitative and Qualitative instruments 16
1.8.1 Quantitative data collection 16
1.8.2 Qualitative data collection 17
1.9 Recruitment, training and Field work 19
1.9.1 Recruitment of the field staff 19
1.9.2 Translation of the schedules and Pre-testing 19
1.9.3 Field Training & Data collection Manuals 19
1.10 Quality assurance processes adopted during baseline field survey 20
1.10.1 Quality assurance processes adopted during the training 20
1.10.2 Productivity and on field scrutiny 20
1.10.3 Role of Supervisor 20
1.10.4 Quality assurance visits by the central teams 20
1.10.5 Monitoring visits by NIPI team 21
1.10.6 Other quality control measures 21
1.11 Data Processing 21
1.12 Report Structure 21
Chapter 2 Household Characteristics 23
2.1 Household demographic profile 23

2.2 Socio-economic profile of household 25
2.3 Education level of the household population 26
2.4 Household characteristics 27
2.5 Household possessions 31
Chapter 3 Characteristics of Survey Respondents 36
3.1 Background characteristics 36

3.2 Exposure to mass media 37
3.3 Employment Status 38
3.4 Age at marriage and first cohabitation 39
Chapter 4 Maternal Health 41
4.1 Preamble 41
4.2 Antenatal Care 41
4.2.1 Pregnancy registration and ANC provider 42

4.2.2 Timing and number of ANC 44
4.2.3 Components of Antenatal Care 46
4.2.4 Health problems and treatment seeking behaviour during pregnancy 49
4.3 Delivery Care 51
4.3.1 Influence of background characteristics on choice of place of delivery 54
4.3.2 Arrangement and cost of transport 56
4.3.3 Institutional delivery 56
4.3.4 Janani Suraksha Yojana (JSY 58
4.3.5 Home deliveries 61
4.4 Postnatal care 65
Chapter 5 Newborn Care 67
5.1 Preamble 67
5.2 Birth weight 67
5.3 Neonatal checkups 69
5.4 Breastfeeding and supplementation 69
Chapter 6 Child Morbidity and Treatment 74
6.1 Prevalence of illness in children under study 74

6.1.1 Point prevalence of diarrhea and illness 74
6.1.2 Diarrhoea 75
6.1.3 Awareness of Diarrhoea 75
6.1.4 Treatment of Diarrhoea 76
6.2 Acute Respiratory Infection 77
6.2.1 Knowledge about pneumonia 77
6.3 Fever 78
6.3.1 Illness with fever and treatment seeking behaviour 78
6.3.2 Feeding practices during illness with fever 79
6.3.3 Care seeking practices during illness with fever 79
Chapter 7 Child Immunization 81
7.1 Preamble 81
7.2 Vaccination coverage 81
Chapter 8 Status of health facilities and Health Management Information System 88
8.1 Introduction 88
8.2 Status Of District Hospital (DHs) 88
8.2.1 Physical Infrastructure 88
8.2.2 Staff in Position 88
8.2.3 Laboratory facility at district hospital 88
8.2.4 Availability of Beds 89
8.2.5 Operation Theater 89
8.2.6 Neonatal equipments and Nursery services 89
8.2.7 Emergency Obstetric Care and MCH facility 89
8.3 Status Of Community Health Center (CHCs) 89
8.3.1 Infrastructure 89
8.3.2 Staff Position 90
8.3.3 Trainings 90
8.3.4 Operation Theatre (OT) and Equipment 90
8.3.5 MCH services 90
8.4 Status Of Primary Health Centre (PHCs) 91
iii
8.4.1 Physical Infrastructure/facilities 91

8.4.2 Staff position 91
8.4.3 Operation Theater and Labour room 91
8.4.4 Equipment (Drug Kits) 92
8.4.5 Furniture 92
8.5 Status Of Sub Centre (SCs) 92
8.5.1 Coverage of SCs 92
8.5.2 Staff 92
8.5.3 Training 92
8.5.4 Regular Supply of Contraceptives and Vaccines 93
8.6 Health Management information system (HMIS) 93
iv
LIST OF TABLES Page No.
Table 1.1: Key health Indicators of the state 7

Table 1.2: Coverage by Target Group and Research Technique (State Level) 7
Table 1.3: Coverage by Target Group and Research Technique (District Level) 7
Table 1.4: Coverage by Target Group and Research Technique (Block level) 7
Table 1.5: Achieved sample 21
Table 1.6: Achieved sample for facility survey 21
Table 1.7: Achieved sample for Qualitative 22
Table 2.1: Household population by age and sex, NIPI-08 23
Table2.2: District wise age and sex distribution – Hoshangabad district, NIPI-08 23
Table2.3: District wise age and sex distribution –Narsimhapur district, NIPI-08 24
Table2.4: District wise age and sex distribution –Raisen district, NIPI-08 24
Table 2.5: Household Composition, NIPI-08 25
Table 2.6: Household Composition, NIPI-08 25
Table 2.7: Household family size by religion, NIPI-08 26
Table 2.8: Education attainment by gender of household member in terms of years of schooling, 26
NIPI-08
Table 2.9: Education attainment by location of PSU in terms of years of schooling, NIPI-08 27
Table 2.10:Type of house, NIPI-08 27

Table 2.11:Source of drinking water, NIPI-08 28
Table 2.12:Drinking water storage and filtration practices 29
Table 2.13:Sanitation facility, NIPI-08 30
Table 2.14:Cooking environment, NIPI-08 30
Table 2.15:Ownership of immovable assets, NIPI-08 31
Table 2.16:Main source of household income, NIPI-08 31
Table 2.17:Household Wealth Index, NIPI-08 33
Table 2.18:Bank account, NIPI-08 34
Table 3.1: Age distribution of women respondents, NIPI-08 36
Table 3.2: Religion and ethnicity, NIPI-08 36
Table 3.3: Education status of women respondents, NIPI-08 37
Table 3.4: Media habits, NIPI-08 37
Table 3.5: Frequency of exposure, NIPI-08 38
Table 3.6: Employment status of eligible women by background characteristics, NIPI-08 39
Table 3.7: Membership in SHGs and mahila mandals, NIPI-08 39
Table 3.8: Age at first cohabitation, NIPI-08 40
Table 3.9: Relationship between age of first cohabitation and education and economic status of 40
respondent, NIPI-08
Table 4.1: Percentage of pregnancies registered vs. key background variables, NIPI-08 42
Table 4.2: Received ANC Card, NIPI-08 43
Table 4.3: Incidence of receiving ANC during last pregnancy, NIPI-08 43
Table 4.4: Place of ANC, NIPI-08 43
Table 4.5: ANC provider, NIPI-08 44
Table 4.6: Number of ANC received and timing of ANCs received, NIPI-08 45
Table 4.7: Proportion of eligible women having received different components of ANC care, NIPI- 46
08
Table 4.8: Nature of ANC service received, NIPI-08 47
Table 4.9: TT injections vs. number of ANCs Nature of ANC service received, NIPI-08 48
Table 4.10:Knowledge about health problems during pregnancy, NIPI-08 49
Table 4.11:Incidence of health problems during pregnancy, NIPI-08 50
Table 4.12:Nature of health problems faced during last pregnancy, NIPI-08 50
Table 4.13:Percentage of women who sought advice for heath problem during pregnancy, NIPI- 51
08
v
Table 4.14:Person persuaded for treatment during pregnancy, NIPI-08 51

Table 4.15:Place of delivery v/s age of respondent, NIPI-08 54
Table 4.16:Place of delivery v/s years of schooling, NIPI-08 54
Table 4.17:Place of delivery v/s number of live children, NIPI-08 55
Table 4.18:Place of delivery v/s economic status of respondents‟ household, NIPI-08 55
Table 4.19:Average transportation expenses, NIPI-08 56
Table 4.20:Nature of Institutional delivery, NIPI-08 56
Table 4.21:Cost incurred in institutional delivery, NIPI-08 56
Table 4.22:Problem experienced during delivery by women of different age groups, NIPI-08 57
Table 4.23:Nature of advice received after delivery by source, NIPI-08 57

Table 4.24:Mothers perception about environment of health facility and behaviour of staff, NIPI- 58
08
Table 4.25:Awareness about JSY, NIPI-08 59
Table 4.26:Accompaniment of ASHA during Institutional delivery, NIPI-08 60
Table 4.27:Duration of stay of the mother at health facility after delivery, NIPI-08 61
Table 4.28:Reason for home delivery, NIPI-08 61
Table 4.29:Home delivery practices, NIPI-08 62
Table 4.30:Person who conduct delivery at home, NIPI-08 63
Table 4.31:Reasons behind choosing a specific person to conduct the delivery, NIPI-08 63
Table 4.32:The delivery process, NIPI-08 64
Table 4.33:Cost incurred in home delivery, NIPI-08 64
Table 4.34:Nature of advice received, NIPI-08 64
Table 4.35:Timings of first postnatal care, NIPI-08 65
Table 4.36:Number of times PNC received, NIPI-08 65
Table 5.1: Recorded weight of baby, NIPI-08 67
Table 5.2: Mother‟s perception about size of newborn, NIPI-08 68
Table 5.3: Timing of first neonatal check-up, NIPI-08 69
Table 5.4: Time of first neonatal check-up by districts, NIPI-08 69
Table 5.5: Breastfeeding practices, NIPI-08 70
Table 5.6: Initiation of breastfeed and gender of child, NIPI-08 71
Table 5.7: Initiation of breastfeed and education of mother, NIPI-08 71
Table 5.8: Initiation of breastfeed and number of live children including index child, NIPI-08 72
Table 5.9: Feeding of prelacteal liquids, NIPI-08 73 72

Table 5.10:Period of exclusive breastfeeding by background variables, NIPI-08 72
Table 6.1: Prevalence of illness in children under study, NIPI-08 74
Table 6.2: Prevalence of illness in children under study 74
Table 6.2: Point prevalence of diarrhoea and illness, NIPI-08 74
Table 6.3: Period prevalence of diarrhoea, NIPI-08 75
Table 6.4: Advice received from ANM or health worker, NIPI-08 76
Table 6.5: Place of treatment, NIPI-08 76
Table 6.6: Proportion of mothers aware of the term pneumonia, NIPI-08 77
Table 6.7: Treatment of pneumonia, NIPI-08 78
Table 6.8: Incidence of fever among children in last 2 weeks prior to survey contact, NIPI-08 78
Table 6.9: Duration of treatment sought during illness, NIPI-08 78

Table 7.1: % of households having vaccination cards on the day of survey, NIPI-08 81
Table 7.2: BCG and Polio „0‟ coverage by background variables, NIPI-08 82
Table 7.3: Polio vaccine coverage by background variables, NIPI-08 83
Table 7.4: DPT vaccine coverage by background variables 83
Table 7.5: Coverage of Measles vaccine and Vitamin A by background variables 84
Table 7.6: Immunization coverage – all basic vaccines 85
Table 7.7: Child Immunisation Coverage in NIPI Districts, MP 85
Table 7.8: Place of immunisation received 86
Table 7.9: Problems faced by mother/community in vaccinating the child 86
vi
Table 7.10:Dropout rate 87
LIS OF FIGURES Page No.
Figure 4.1: Registration of pregnancies by type of facilities 42

Figure 4.2: Percent of Mothers who received three or more antenatal checkups 45
Figure 4.2.3: Percent of Mothers who consumed IFA for 90 days and Received 2 or more TT 46
during Pregnancy
Figure 4.3.1: Percentage of Institutional deliveries - MP and India 52
Figure 4.3.2: Percentage of births assisted by health personnel 52
Figure 4.3.3: Percentage of Births assisted by skilled personnel in NIPI districts 53
Figure 5.1: Time of initiation of Breast-feeding 71
Figure 6.1: Type of practices to be followed if child gets diarrhoea* 75
Figure 2: Awareness of symptoms of pneumonia 77
Figure 3: Preventive measures taken for avoiding child sickness 79
ANNEXURE 95
A1 Household possession – NIPI districts 96

A2 Type of health schemes- NIPI districts 97
A3 Education Attainments vs. age of respondent 98
A4 Frequency of reading a newspaper or magazine vs. key background variables. 99
A5 Frequency of listening to the radio vs. key background variable 99
A6 Frequency of watching television vs. key background variables 100
A7 Employment Status 100
A8 Children ever born vs. age of mother 101
A9 Treatment seeking behaviour 102
A10 Diarrhea practices 103
A11 Quantity of food and drinks taken while having fever 104
A12 Advice received from sources & duration of treatment for illness 104
A13 Child having health problem during illness 105
A14 Problems faced during availing treatment for illness 105
A15 Medicines taken during illness 105
A16: Money spent on treatment while having illness 106
A17: Nutritional Status of Children - MP and NIPI districts, DLHS-RCH, 2002-03 106
A18: Indicators of Child Feeding Practices MP and India 106
A19: Budget Allocated and Expenditure for MP 107
A20: Budget allocated and utilized by Programme in NIPI districts 107
A21- A37 District Hospitals 108
A37- A58 Community Health Center 114
A59-A70 Public Health Centre 121
A70-A77 Sub Center 128
vii
District: HOSHANGABAD
Baseline Summary Indicators
Indicator Total %
Mothers registered in the first trimester when they were pregnant with last live birth/still birth 706 61.7
Mothers who had at least 3 Ante-Natal Care visits during the last pregnancy 729 63.7
Total number of deliveries (home plus institutional) 1184
Institutional deliveries 1001 84.5
Average Retention period (hours) in case of institutional delivery 74
Post natal care provided to mother and neonates - Children had check-up within 24 hours 577 48.7
after delivery (based on last live birth)
Post natal care provided to mother and neonates -Children had check-up within 10 days 751 63.4
Mothers who received post natal care within 48 hours of delivery of their last child 696 58.8
Referral done for mothers with illness and complications during pregnancy 416 78.8
Children with Diarrhoea in the last two weeks who received ORS 39 26.9
Children with Diarrhoea in the last two weeks who were given treatment 116 80.0
Children with acute respiratory infection/fever in the last two weeks who were given 63 84.5
treatment
Children (age 6 months above) exclusively breastfed 323 38.5
Children (12-23 months) fully immunized (BCG, 3 doses each of DPT, and Polio and 208 62.5
Measles)
New born Babies immunized with zero dose polio and BCG 151 45.3
New born Babies – breastfed within 1 hour of birth 417 35.5
Newborn with birth weight taken after delivery at home 14 7.8
District: NARSIMHAPUR
Indicator Total %
Post natal care provided to mother and neonates -Children had check-up within 10 days after 379 35.1
delivery (based on last live birth)
Children with acute respiratory infection/fever in the last two weeks who were given treatment 79 58.5
Children (12-23 months) fully immunized (BCG, 3 doses each of DPT, and Polio and 180 59.8
Measles)
1
District: RAISEN
Indicator Total %
Post natal care provided to mother and neonates -Children had check-up within 10 days after 621 52.4
delivery (based on last live birth)
Children with acute respiratory infection/fever in the last two weeks who were given treatment 222 81.0
Children (12-23 months) fully immunized (BCG, 3 doses each of DPT, and Polio and Measles) 149 46.6
2
Chapter 1
Introduction
1.1 Background of NIPI
As per the Millennium Development 4 Goals (MDG) India has to reduce its Child Mortality Rate
(CMR) by two-thirds between 1990 and 2015. It implies that India has to reduce its under five
mortality rate to 38 per 1000 live births by 2015 (UNICEF SOWC 2008) to achieve the MDGs.
However, the office of the registrar general of India has recently cautioned that, after a rapid
decline during 1980-90, the IMR in India has stagnated since 1993 at the level of 72 [GoI 2000]
This means that the programs which addressed the problem of child mortality (reproductive and
child health program, immunization program, ICDS) were no longer effective in further reducing
the IMR, and a larger proportion of infant deaths were now contributed by neonatal deaths
because this component is influenced little by the current programs [GoI 2000]. India has made
progress in the reduction of child mortality with the average annual rate of reduction in U5
mortality between 1990 and 2006 being around 2.6 per cent.
If India is to reach the MDG Goal of 38 by 2015, the average annual rate of reduction over the
next nine years must be far higher, or around 7.6 per cent. (Source: UNICEF, SOWC 2008)
Efforts of Norway India Partnership Initiative
For India‟s success in achieving Millennium Development Goal four (MDG 4), Norway-India
Partnership Initiative (NIPI) is a collaboration towards the reduction of child mortality in Indian
states. Norway and India have agreed to collaborate towards achieving MDG 4 based on
commitments made by the Prime Ministers of the two countries.
The NIPI intends to provide an up-front, catalytic and strategic support to accelerate the
implementation of National Rural Health Mission (NRHM 2005-2012) in five states that comprise
40% of India‟s total population and account for around 60% of child deaths viz., Uttar Pradesh,
Bihar, Madhya Pradesh, Rajasthan and Orissa and evolve multiple partners, including UNICEF
and WHO. About 2.4 million children under the age of five die every year in India, of which 1.4
million die in the 5 NIPI focus states. These states pose an enormous challenge in
implementation because of the socio-economic factors, large inequalities, weak health system
and poor program management capacity.
The initiative aims to achieve measurable outcomes in line with the fourth ''millennium
development goals'' (MDG-4) including a sustained routine immunisation coverage rate at 80 per
cent or more from 2007 onwards and saving an additional 0.5 million under-5 children each year
from 2009.
The Norway India Partnership Initiative will focus on four core areas in the five high-prevalence
states
 Strengthening the National Rural Health Mission, by supporting an independently

managed enabling network and facilitating delivery of MDG-4 related services
 Testing and introduction of new ways of scaling up quality services by community health
workers (ASHAs) at the village level in the five states including their support needs and
referral requirements
 Involving the private sector in the delivery of MDG 4 related services at all levels
 Exploring and providing upfront catalytic financial and strategic support for new
opportunities under the NRHM-MDG-4 related activities
4
NIPI is planned to test some innovative ideas and provide various inputs to the existing RCH
programs under NRHM. These interventions are expected to have impact on the service delivery
and outcome. In order to achieve the monitoring and evaluation objectives, the initiative will have
a comprehensive baseline assessment on child and related maternal health care in the four NIPI
focus states.
This baseline study is conducted during the year 2008-2009 in three phases (each phase covered
three Districts from NIPI states) in 12 Districts. For the study in 2 states (MP and Orissa )
Taylors & Nielsen Sofreys (TNS Pvt. Ltd) was designated as research agency and for 2 states
(Bihar and Rajasthan) Development & Research Society (DRS) was designated as research
agency, additionally, TNS Pvt Ltd was also assigned the Executive Summary report of findings
from all 4 states
1.2 Research Objectives
The present baseline survey on child and related maternal health care has the following
objectives:
1. Identifying gaps in the existing service delivery mechanism to reduce infant mortality and
to improve maternal health
2. Assessment of Needs and opportunities at various levels
3. Developing benchmark indicators for the implementation of the project
1.3 Study Phases
This current baseline study comprises of three phases, viz.,
1 Review of available literature on child health and related maternal health, desk research and
field review to identify information gaps
2 Collection of data on the identified gaps (not limited to) by using qualitative and quantitative
research techniques
3 Dissemination of study findings and summary report generation
The Phase 1 of NIPI Baseline survey was conducted during the year 1998 in the month of
February- March. In Phase 1, information about child and related maternal health care was
collected through desk research and interviews were conducted with the health functionaries and
other stakeholders at state and District levels.
In Phase 2, the survey was conducted during December 2008 and January 2009. For Phase 2,
interviews were conducted at block and village level with the service providers and block officials
who cater to the needs of child and maternal activities. The study states were Orissa, Madhya
Pradesh, Bihar and Rajasthan. This report contains the detailed findings for the state of Orissa.
1.4 Study Area
In this baseline survey, the data were collected from the three NIPI focus districts; Hoshangabad,
Raisen and Narsimhapur and relevant information from the State level. The districts selected by
NIPI in consultation with the State NRHM for implementation of the interventions.
1.5 Ongoing health related programs in MP
In order to improve the implementation of several child and related maternal health activities,
certain programs are ongoing programs such Janani Suraksha Yojana, Janani Express, Mamta
and Vijaya Raje Janani Kalyan Beema Yojana in child and related maternal health.
5
1.6 Demographic profile of NIPI states
1.6.1 About Madhya Pradesh and NIPI states
Madhya Pradesh, as its name implies, is located at the geographic centre of India. Madhya
Pradesh occupies perhaps the oldest part of the subcontinent. It covers an area of 3,08,245 sq.
km, making it the biggest state in the country, bordering seven other states - Uttar Pradesh,
Bihar, Orissa, Andhra Pradesh, Maharashtra, Gujarat and Rajasthan.
The state consists of 48 districts, 313 blocks and 55393 villages. The State has population
density of 195 per sq. km. (as against the national average of 312).
In MP, there are 48 districts- MP districts namely Hoshangbad, Narsimhapur and Raisen are
selected by NIPI for specific intervention programs.
The following chart provides a view of the trend of gross state domestic product of MP at market
prices estimated by Ministry of Statistics and Programme Implementation, GoO with figures in
millions of Rupees.
Year Gross State Domestic Product

1980 77,880
1985 139,050
1990 304,720
1995 478,410
2005 1,044,850
Madhya Pradesh's gross state domestic product for 2004 is estimated at $32 billion in current
prices. After partition, the new Madhya Pradesh state produces about 70% of the output of the old
6
Madhya Pradesh state - the rest is produced by Chattisgarh. Between 1980 and 2000 the gross
domestic product grew from 77,880 million rupees to 737,150 million rupees.
Between 1999 and 2008, the annualized growth rate was very low 3.5%. According to the India
State Hunger Index, Madhya Pradesh has one of the worst malnutrition problems in the world
According to census of 2001, 91.1% followed Hindu religion while others are Muslim (6.40%),
Jain (0.9%), Christians (0.30%), Buddhists (0.30%), and Sikhs (0.20%). The scheduled castes
and scheduled tribes constitute a significant portion of the population of the State. The scheduled
castes are 13.14% while scheduled tribes were 20.63%.
Table 1.1: Key health Indicators of the state
Health care indicators Sources MP

Total population Census of India 2001 (in 60.35
million)
Decadal Growth (%) Census 2001 NA
Crude Birth Rate SRS 2007 28.5
Crude Death Rate SRS 2007 8.7
Total Fertility Rate NFHS-III 3.1
Women with 2 children want No more children (%) NFHS-II 82
NFHS-III 60.1
Women with 2 daughters Who Want No More Children (%) NFHS-II 38
NFHS-III 19.5
Trend in any modern method NFHS-II 43
NFHS-III 53
Trends in Fertility NFHS-II 3.4
NFHS-III 3.1
Trends in contraceptive Use NFHS-II 44
NFHS-III 56
Trends in any Antenatal Care NFHS-II 63
NFHS-III 81
Trend in Antenatal Care (3 ANC visits)- % of women who NFHS-II 27.1
received 3 ANC visits NFHS-III 40.2
Trends in institutional delivery NFHS-II 22
NFHS-III 30
Trends in full immunization (% of children age 12-23 months NFHS-II 22.6
received BCG+ 3 Polio +3 DPT +Measles) NFHS-III 40.3
Percentage of children Age 12-23 Months received BCG NFHS-II 62
NFHS-III 81
Percentage of children Age 12-23 Months received Measles NFHS-II 34
NFHS-III 61
Percentage of children age 12-23 months received 3 DPT NFHS-II 36
NFHS-III 50
Infant Mortality Rate NFHS-II 80
NFHS-III 70
Maternal Mortality Ratio SRS 2001 - 2003 379
Sex Ratio Census 2001 919
Female Literacy Rate (%) Census 2001 50.3
7
1.6.2 Profile of Hoshangabad district
Hoshangabad district is the Indian state of Madhya Pradesh. It is a city in the central India region,
located on the south bank of the Narmada River, and is the administrative center of
Hoshangabad District, the district of Hoshangabad has a total area of 5408.23 sq. km.
Hoshangabad has a
population of 97,357 (census
of 2001). Males constitute
53% of the population and
females 47%. Hoshangabad
has an average literacy rate
of 73%, higher than the
national average of 59.5%:
male literacy is 80%, and
female literacy is 66%.
In Hoshangabad District,
there are 17 Primary Health
Centres, 3 Community Health
Centres and 150 Sub-Health
Centres. Besides these, there
are 6 Homeopathic Centres
and one is Unani Hospital
along with 39 Ayurvedic
Hospitals in the district. Besides these hospitals and dispensaries, the selected private nursing
home and hospitals are also available in the district. One military hospital is also available in the
Itaris town and Pachmarhi.
Facilities have been provided to all on the programmes of Family Planning, Blindness Control,
Vaccination Programme and other Immunization Programme under the various state government
schemes. One mobile clinic is also operational under Jiwan Jyoti Programme in the district for the
Tribal Area. Some camps are also organized for the villagers in connection with Blindness,
Immunization, etc.
8
FACT SHEET, DISTRICT - HOSHANGABAD, MP

DLHS – 2 DLHS – 3 Baseline
Indicators (2002 – 04) (2007 – 08) (2008 – 09)
Maternal Health: Total Rural Total Rural Total Rural
Mothers registered in the first trimester when they
- - 48.0 38.7 61.7 58.7
were pregnant with last live birth/still birth (%)
Mothers who had at least 3 Ante-Natal Care visits
43.8 32.4 43.4 34.2 63.7 58.9
during the last pregnancy (%)
Mothers who got at least one TT injection when they
75.3 68.7 74.7 68.0 99.6 99.6
were pregnant with their last live birth / still birth (%) #
Institutional births (%) 36.8 26.0 65.6 58.0 84.5 82.4
Delivery at home & other places assisted by a
3.2 3.7 2.7 2.2 - -
doctor/nurse /LHV/ANM(%)
Mothers who received post natal care within 48 hours
- - 63.8 55.7 58.8 58.7
of delivery of their last child (%)
Child Immunization and Vitamin A
supplementation:
Children (12-23 months) fully immunized (BCG, 3
65.5 61.3 54.0 53.5 62.5 61.8
doses each of DPT, and Polio and Measles) (%)
Children (12-23 months) who have received BCG (%) 86.9 85.2 96.5 95.9 91.0 92.2
Children (12-23 months) who have received 3 doses
69.0 63.9 73.6 71 83.5 83.9
of Polio Vaccine (%)
69.0 63.9 65.0 60.9 82.9 83.4
of DPT Vaccine (%)
Children (12-23 months) who have received Measles
69.4 63.9 80.0 80.4 69.4 66.8
Vaccine (%)
Children (9-35 months) who have received at least
- - 58.9 52.3 - -
one dose of Vitamin A (%)
Children (above 21 months) who have received three
- - 15.2 3.3 - -
doses of Vitamin A (%)
Treatment of childhood diseases (children under 3 years based on last two surviving
children)
Children with Diarrhoea in the last two weeks who
22.6 19.5 22.1 19.9 26.9 25.0
received ORS (%)
60.9 54.8 67.5 70.4 80.0 76.8
were given treatment (%)
Children with acute respiratory infection/fever in the
- - 63.6 60.7 84.5 82.2
last two weeks who were given treatment (%)
Children had check-up within 24 hours after delivery
- - 63.9 57.4 48.7 50.6
(based on last live birth)(%)
Children had check-up within 10 days after delivery
- - 63.5 55.9 63.4 62.4
(based on last live birth) (%)
Child feeding practices (Children under 3 years)
Children breastfed within one hour of birth (%) - - 47.0 47.1 35.5 -
Children (age 6 months above) exclusively breastfed
- - 30.6 31.8 39.0 -
(%)
Children (6-24 months) who received solid or
- - 88.7 88.3 - -
semisolid food and still being breastfed (%).
Problems faced during pregnancy (% of Mothers) - - - - 44.6 43.4
Post Delivery Retention Period of Mother at Health
- - - - 54.8 52.5
Facility (average in hours)
Age at first cohabitation / Average age of marriage - - - - 18.2 17.7
9
1.6.3 Profile of Narsimhapur district
Narsimhapur district is situated in the central part of the state of Madhya Pradesh and lies
between north latitude 22º 45' to 23º 15' and east longitude 78º 38' to 79º 38'. The district has a
total area of 5125.55 square kilometers and a population of 9,57,399.The district's economy
depends on agriculture and forest resources.
Males constitute 52% of the population and females 48%. Narsimhapur has an average literacy
rate of 77%, higher than the national
average of 59.5%: male literacy is
82%, and female literacy is 72%. In
Narsimhapur, 12% of the population
is under 6 years of age.
The Urbanization rate in the district is

16%. The district consists of 6
development blocks, 5 towns and
1040 inhabited villages with the
district HQ being Narsimhapur town
(population 46,120 –2001 census).
In Narsimhapur district, there are 2

government hospital/dispensaries, 20
PHC, 144 Sub centers and 63
Aryuvedic /homeopathic/Unani
/hospitals.
Specific schemes are working for the

health of child and maternal care in
the districts such as National
Motherhood Assistance (Rastriya Matrutava Sahayata)for poor class women during their
pregnancy get the medical assistance with help of this scheme. Under this scheme economically
weaker section women who are pregnant and having age more them 19 years. She gets a lump
sum amount of Rs. 500/- between 8 to 12 weeks before the pregnancy. This benefit is given
upped two children only,
Ayushmati Scheme: Under this scheme landless poor rural women get the medical treatment
specially. Eligible omens gets 400/- PM if get admitted in Distt. Civil Hospitals for a week and Rs.
1000/- PM if the period is more than a week.
Balika Samridhi Yojna: Women living under Below Poverty Line (BPL) gets financial assistance
of Rs. 500/- per girl child upped two live deliveries of girl child and women must attain 19 years of
age. A scholarship of Rs. 300/- is given to the girl child for studies from standard 1st to 3rd, Rs.
400/- in class 4th, in class 5th Rs. 500/-, in class 6th and 7th Rs. 600/-,in class 8th Rs. 800/- and
in class 9th and 10th Rs. 1000/- per annum.
10
FACT SHEET, DISTRICT - NARASIMHAPUR, MP

Indicators (2002 – 04) (2007 – 08) (2008 – 09)
Mothers registered in the first trimester when they were
pregnant with last live birth/still birth (%) - - 43.2 39.4 58.0 55.1
Mothers who had at least 3 Ante-Natal Care visits during
the last pregnancy (%) 31.3 26.2 48.1 42.0 45.4 41.1
Mothers who got at least one TT injection when they were
pregnant with their last live birth / still birth (%) # 70.0 67.2 80.3 77.5 99.8 99.8
Delivery at home & other places assisted by a doctor/nurse
/LHV/ANM(%) 4.6 2.3 3.2 3.4 - -
Mothers who received post natal care within 48 hours of
delivery of their last child (%) - - 46.9 42.4 21.0 19.2
Child Immunization and Vitamin A supplementation:

Children (12-23 months) fully immunized (BCG, 3 doses 48.3 47.0 40.5 39.9 59.8 62.9
each of DPT, and Polio and Measles) (%)
Children (12-23 months) who have received 3 doses of 59.1 57.8 57.3 53.6 79.7 83.3
Polio Vaccine (%)
Children (12-23 months) who have received 3 doses of 57.0 55.4 55.9 53.3 77.7 81.7
DPT Vaccine (%)
Children (12-23 months) who have received Measles 60.0 60.2 62.0 56.0 64.5 65.8
Vaccine (%)
Children (9-35 months) who have received at least one - - 43.0 41.1 - -
dose of Vitamin A (%)
Children (above 21 months) who have received three - - 3.0 3.5 - -
children)
Children with Diarrhoea in the last two weeks who received 28.0 23.6 34.8 33.7 29.9 24.1
ORS (%)
Children with Diarrhoea in the last two weeks who were 52.0 51.0 60.1 55.9 68.8 69.0
given treatment (%)
Children with acute respiratory infection/fever in the last - - 65.4 62.9 58.5 55.7
two weeks who were given treatment (%)
Children had check-up within 24 hours after delivery - - 49.8 45.2 5.3 3.9
Children had check-up within 10 days after delivery (based - - 53.1 48.4 31.5 28.6
on last live birth) (%)
Children (age 6 months above) exclusively breastfed (%) - - 23.2 23.1 21.0 -
Children (6-24 months) who received solid or semisolid - - 87.4 86.9 - -
food and still being breastfed (%).
Post Delivery Retention Period of Mother at Health Facility - - - - 58.9 59.1
(average in hours)
11
1.6.4 Profile of Raisen district
Raisen is a district of the state of Madhya Pradesh and lies between north latitude 22º 47' to 23º
33' and east longitude 77º 21' to 78º 49'. With the district headquarters situated at Raisen town,
the total area of the district is 8,395 square kilometers and has a population of 1,20,159.
Raisen District is situated just 45 Kms. away from Bhopal by Road. All the Block Head quarters
are well connected with Road. But as far as Primary Healthy Centre is concerned some of them
do not have adequate approach roads, which makes difficult for people to access the health
facilities especially in rainy season. Similarly, there is desperate need for roads at Sub Health
Centre which are unapproachable during rainy season.
Males constitute 53%

of the population and
females 47%. Raisen
has an average literacy
rate of 66%, higher
than the national
average of 59.5%: male
literacy is 72%, and
female literacy is 59%.
In Raisen, 15% of the
population is under 6
years of age.
The economy of the

district is agriculture
based and wheat, pea
and soybean are the
main crops cultivated.
Raisen is a dream
destination for tourists
and holiday seekers.
Places like Sanchi, Bhojpur and Bhimbhetika are full of historical and natural attractions.
The Urbanization rate in the district is 18.4%. The district consists of 7 development blocks, 10
towns and 1429 inhabited villages with the largest being Mandipeep town (population 39,898 –
2001 census).
In Raisen district, there are 175 SHC, 22 PHCs, 6 CHCs and 1 DH. The Tuesdays and Fridays
are fixed for the static and out reach session for immunization. Schemes such as Ladli Laxmi
Yojana and Innovative schemes such as Janani Express, Vijayraje Janani Kalyan Bima Yojana
are ongoing for encouraging institutional deliveries and safe motherhood.
`
12
FACT SHEET, DISTRICT - RAISEN, MP

Indicators (2002 – 04) (2007 – 08) (2008 – 09)
Mothers registered in the first trimester when they
- - 29.1 25.9 50.6 51.4
were pregnant with last live birth/still birth (%)
Mothers who had at least 3 Ante-Natal Care visits
30.7 26.9 27.1 24.3 45.2 43.2
during the last pregnancy (%)
Mothers who got at least one TT injection when they
68.1 64.3 51.1 48.7 99.9 100.0
were pregnant with their last live birth / still birth (%) #
Delivery at home & other places assisted by a
10.1 10.7 2.0 2.2 - -
doctor/nurse /LHV/ANM(%)
Mothers who received post natal care within 48 hours
- - 22.6 19.8 43.4 41.9
of delivery of their last child (%)
Child Immunization and Vitamin A
supplementation:
Children (12-23 months) fully immunized (BCG, 3
24.4 19.4 39.2 37.1 46.6 47.2
doses each of DPT, and Polio and Measles) (%)
37.9 34.7 55.1 53.0 73.1 72.5
of Polio Vaccine (%)
42.0 39.8 46.5 42.5 71.3 70.6
of DPT Vaccine (%)
Children (12-23 months) who have received Measles
34.8 26.5 62.6 60.2 52.2 53.2
Vaccine (%)
Children (9-35 months) who have received at least
- - 39.5 35.4 - -
one dose of Vitamin A (%)
Children (above 21 months) who have received three
- - 2.6 2.9 - -
children)
26.0 27.9 34.4 35.4 23.3 23.5
received ORS (%)
48.9 54.2 55 54.7 73.6 75.3
were given treatment (%)
Children with acute respiratory infection/fever in the
- - 51.9 47.2 81.0 82.6
last two weeks who were given treatment (%)
Children had check-up within 24 hours after delivery
- - 21.4 19.5 28.4 28.3
Children had check-up within 10 days after delivery
- - 22.9 20.9 52.4 50.8
(based on last live birth) (%)
Children (age 6 months above) exclusively breastfed
- - 37.8 35.4 34.0 -
(%)
Children (6-24 months) who received solid or
- - 91.4 90.4 - -
semisolid food and still being breastfed (%).
Post Delivery Retention Period of Mother at Health
- - - - 51.7 51.6
Facility (average in hours)
13
1.7 Survey Design
In Phase II, the sampling frame took into consideration district, village, and household units. The
target population included was women who gave birth within the past two years, as these are the
main beneficiaries of the interventions to be provided by NIPI and the outcome indicators needed
for the study was generated by interviewing them.
Note: The sampling strategy given below describes the methods of selecting the respondents
from a study district.
1.7.1 Sampling strategy at district level
We used a two-stage stratified cluster sampling technique for the selection of respondents
(women who gave birth during the past two years) in this study. We covered 50 PSUs from each
of the study districts. The number of clusters covered in a district was allocated according to the
proportion of rural and urban population in the district. At the first stage, number of rural
PSUs/villages was selected using probability proportional to size (PPS) sampling technique.
Within the PSU/village, selection of the eligible respondents was done using systematic random
sampling approach.
Similarly the allocated number of urban PSUs/wards was selected using probability proportional
to size (PPS) sampling technique. Within the PSU/ward selection of the eligible respondents was
done using systematic random sampling approach. The 2001 Census list of towns/cities and
villages of the study districts served as the sampling frame for the selection of PSUs. As the
selection of the respondents is done randomly using two-stage sampling strategy each individual
member of the target group of respondents in the district had an equal chance of inclusion in the
survey.
Inclusion Criteria
 Households with currently married women who delivered a child in last two years or who
were pregnant in the last two years.
 Oral informed consent of the selected respondent
 Sample size determination in NIPI Baseline study
Sample size determination in NIPI Baseline study

The following formula was used to determine the sample size required in a district:
nD
 2 P(1  P) Z1  P1 (1  P1 )  P2 (1  P2 ) Z1  
2
2
Where:
D = Design effect
P1 = the estimated proportion at the time of the baseline survey;
P2 = the proportion at end line such that the quantity (P2 - P1) is the size of the magnitude of
change it is desired to be able to detect;
14
P = (P1 + P2) / 2;
Z1- = the z-score corresponding to the probability with which it is desired to be able to conclude
that an observed change of size (P2 - P1) would not have occurred by chance; and
Z1- = the z-score corresponding to the degree of confidence with which it is desired to be certain
of detecting a change of size (P2 - P1) if one actually occurred.
 =0.05 (Z1- = 1.96); =0.20 (Z1-=0.84); D = 2
With a power of 80 percent and with 5% precision, the sample size required at 95% confidence is
obtained for different variable values for both Madhya Pradesh and Orissa. We considered 3
variables namely, IMR, NMR and percentage deliveries taken place in institutions.
The following table provides the sample size required at district level
Indicator State D Sample Size

Source of data p1 P2 Live births Households Including
20% non-
response
NFHS3 IMR Orissa 2 0.091 0.0455 1441 7067 8481
NFHS3 IMR MP 2 0.094 0.047 1392 6825 8189
NFHS3 NMR Orissa 2 0.046 0.023 2958 14505 17407
NFHS3 NMR MP 2 0.045 0.0225 3027 14840 17808
NFHS3 % Inst Mean 2 0.26 0.19 1003* 1204*
deliveries
*1200 pregnant women
The objective of NIPI program is to act as a catalyst in the process, which leads to reduction in
infant and neonatal mortality. The objective of NIPI intervention is not to reduce infant mortality
directly. So using IMR or NMR for the calculation of sample size is not ideal. Percentage of
institutional deliveries is an indicator of the improvement in service delivery, which will have direct
bearing on the survival of newborn. Taking a bigger sample size has implications on cost and
time. So a sample size of 1200 was decided for each district, which provided us statistically viable
estimates for most of the indicators under consideration.
Sampling procedure
Primary sampling units
The allocated number of villages/wards (PSUs) within a district was selected using Probability
proportional to size (PPS) technique and by involving all the villages/wards in the district. The
sampling interval was obtained by dividing the total cumulative population of the district by the
total number of villages/wards. All villages/wards was listed in one column, their corresponding
population in another column and the cumulative population in yet another column. A random
start of villages/wards was included and was done by selecting a random number between 1 and
the maximum number in the sampling interval. The remaining villages/wards was then selected
by adding the sampling interval to the cumulative population of villages/wards.
Listing of eligible women in a PSU
Each selected PSU was initially listed for the identification of eligible respondents (woman who
delivered a baby in the last two years or woman who was pregnant in the last two years). After
listing the eligible respondents in a PSU, from each PSU we covered 24 eligible respondents
using systematic random sampling approach. It implies that from each PSU we have information
15
about 24 pregnancies irrespective of their outcome and from a district, we have information about
24x50=1200 pregnancies at baseline. Thus we covered a total sample size of 3600 pregnancies
in a state.
As per the suggestion from TAC, sample size was recalculated using the variable „percentage of
children fully immunised‟. Attached excel sheet provides the estimate. After adjusting for design
effect and non-response, the sample size achieved was 1200.
As suggested by earlier by TAC, it was decided to cover 1200 samples of children in the age
group of 12-23 months, 600 infants (in less than one year) and all the neonates (0-28 days) in the
PSU. With the understanding of covering 10 percent of the samples, a sample size of 24
children/respondents per PSU was worked out with 10 percent of over sampling to avoid the risk
of unresponsive candidates.
With a sample size of 24 children aged 0-23 months per PSU, we got one neonate per PSU
resulting in a total sample size of 50 neonates in the study. In order to get statistically robust
estimates of indicators of newborn care practices and contacts by health worker, a sampling size
of 136 was derived. So with the propose quota sampling wherein, from each PSU, we selected 2-
3 neonates (<1 month), 9-10 children of 1-11 months and 12 children of 12-23 months. This
sample size was adequate to get an estimate of the indicator under consideration with 95%
confidence, 10% precision and a design effect of 2.
The sample size proposed and in each segment, confidence limit, precision and achieved sample
size are given in the grid below.
Segment Sample Size Confidence Limit Precision* Achieved

proposed sample size
Neonates (0-28 days) 136 95% 10% 229
Infant including neonates 550 95% 5% 1606
Children 12-23 months 600 95% 5% 1843
*The assumption is that the estimate of the indicator is 50%
Assuming that the crude birth rate was 30 per 1000 population (equivalent to 200 households,
assuming household size of 5), we got 2-3 neonates per 200 households. We listed a maximum
of 400 households in each village so that required numbers of mothers of neonates were
available for interview in each village. If village size was less than 400 households, pooling of
village(s) adjacent to the selected village with the selected village was done to make sure that the
village size is at least 400 households
Since the crude birth rate in urban areas was comparatively lower, we listed minimum 500
households in urban areas. Segmentation of wards was done in such a way that each segment
had 500 households.
1.8 Quantitative and Qualitative instruments
The baseline data needed for the present study was obtained by using qualitative and
quantitative data collection techniques and the target groups for the surveys were different
stakeholders who were the beneficiaries and the implementers of the maternal and child health
care interventions in the selected study districts and the states.
1.8.1 Quantitative data collection
As part of Quantitative survey we conducted cross-sectional survey based on the WHO and
UNICEF Rapid Assessment Procedure.
Questionnaire
16
Information on various indicators pertaining to MCH was collected that would assist policy makers
and program managers to formulate and implement the goals set for NIPI program. TAC steering
committee had reviewed and made necessary modifications in one of the Questionnaires:
Women Questionnaires.
These questionnaires were discussed and finalized in training cum workshop during the first week
of November 2008
All the questionnaires were bilingual, with questions in both regional and English language.
The details of questionnaires are as follows:
Household Questionnaires: the household questionnaire lists all usual residents in sample
household including visitors who stayed in the household the night before the interview. For each
listed household member, the survey collected basic information on age, sex and education.
Information was also collected on the household characteristics such as main source of drinking
water, type of toilet facility, source of cooking fuel, religion and caste of household head and
ownership of other durables goods in the household.
Women Questionnaire: Women questionnaire is designed to collect information from currently

married women 15-45 years who gave birth in last two years.
The women questionnaire covered the following sections:
Section I: Women characteristics: In this section the information collected on age, educational
status and birth and death history of biological children including still birth, induced and
spontaneous abortions.
Section II: In this section the questionnaire collect information only from the women who had live
birth, still birth, spontaneous or induced abortion during last two years preceding the survey date.
The information on whether women received antenatal and postpartum care, who attended the
delivery and the nature of complication during pregnancy for recent births were also collected.
Section III: Institutional Delivery: This section gives information about women who went to health
facility for delivery, mode of transport arranged for delivery, assistance provided by ASHA,
experience of health problems during the time of delivery and advises given by health
practitioners on newborn care practices.
Section IV: Home Delivery: This section covers the information about deliveries conducted at
home, place used for home delivery, health personnel attended to conduct the delivery, clean
practices adopted for delivery, check up conducted by ASHA
Facility Questionnaire: The information collected at District hospital, Community Health Centre,
Public Health Centre and Sub- Centre on the availability of functionality of human resource
(clinical /paramedical), physical infrastructure/ facilities, training to staff, equipments and services
provided.
1.8.2 Qualitative data collection
As part of Qualitative study, we conducted in-depth interviews (IDI) with various stakeholders
involved in maternal and newborn care issues at village, block, district and state level. The
purpose of qualitative study was to assess the input, process and output indicators of the
interventions proposed. It may be noted that the main purpose of quantitative survey was to
understand the different aspects of program delivery and management as a facilitating/debilitating
factor to contain mortality levels of infants and P/L mothers.
Qualitative study was carried out through In-depth interview of various health
functionaries/stakeholders in a state, district and block level.
17
Table 1.2: Coverage by Target Group and Research Technique (State Level)
Target Group Research Per Per
Technique district state
Health/ FW/RCH Director IDI 2 6
NRHM-PMU/ Mission Director IDI 1 3
ICDS-PD/ Commissioner IDI 1 3
NGO Coordinator IDI 1 3
PO - Immunisation IDI 1 3
Consultant – Child Health IDI 1 3
PO – Planning/SPM IDI 1 3
DD-Statistics IDI 1 3
Finance Officer IDI 1 3
State IEC Officer IDI 1 3
Table 1.3: Coverage by Target Group and Research Technique (District Level)
DM/ DC IDI 1 3
CMHO IDI 1 3
DIO IDI 1 3
DIECO IDI 1 3
NRHM- DPM IDI 1 3
DAM IDI 1 3
MIS Officer IDI 1 3
RKS IDI 1 3
ICDS-PO IDI 1 3
NGO IDI 1 3
Provider Association – IMA, Pvt Doctor Association, Nurses
IDI 1 3
Association
District hospital, Civil Surgeon IDI 1 3
Table 1.4: Coverage by Target Group and Research Technique (Block level)
ASHAs of the surveyed PSUs IDI 50 150
AWWs of the surveyed PSUs IDI 50 150
PRI leader IDI 50 150
VHSC IDI 50 150
ANM IDI 25 75
ANM FGD 3 9
BEE IDI 5 15
BMO IDI 5 15
CDPO IDI 5 15
LHV IDI 5 15
18
1.9 Recruitment, training and Field work
1.9.1 Recruitment of the field staff
For this baseline household survey, supervisors and interviewers from the respective states were
recruited, with relevant background and previous experience in similar large-scale social research
studies. We recruited graduates only for the job of Supervisors and Interviewers and with the fix
minimum experience in social surveys for interviewers as 2 years and for supervisors as 5 years.
The qualitative survey was monitored by a researcher who has previous experience in handling
such surveys.
For the quantitative baseline survey in a state, we recruited 15 teams. Each team comprised 1
supervisor 5 female investigators and 1 field editor per state. With a productivity of four
interviews for investigator per day the quantitative survey of 6000 interviews per state we
completed in 30 days and an additional 10 days was completed for travel between the PSUs.
Thus Quantitative part of the survey was completed in around one and half months of time.
For listing the eligible respondents in a PSU we recruited a team of one person for listing and one
for mapping. Like this we recruited 20 such teams. Each team listed a PSU in two days time.
Thus a state with 201 PSUs covered by such 20 teams in a month‟s time including travel between
the PSUs.
For conducting IDIs component of the Qualitative survey, we recruited 5 teams. Each team
comprised of four male interviewers and one male supervisor. The male interviewers did IDIs of
ASHAs, AWWs, PRIs and ANMs. Supervisors conducted interviews with block and district level
officials. With a productivity of 2 IDIs per investigator per day the 760 component of the survey
was completed in a month‟s time.
1.9.2 Translation of the schedules and Pre-testing
All the qualitative and quantitative instruments of the present study were translated into regional
languages by TNS panel of expert translators. The translated schedules were translated back into
English and variations if any will be sorted out.
All the prepared instruments were pre-tested on eligible respondents by the local investigators
from study states. All the questions were assessed for consistency, comfort of the investigator to
enquire and the respondent‟s convenience to respond.
The client modified the instruments according to the feedback provided by us. Then the
instruments were sent for printing. We printed the required number of instruments + 10% more to
be used in training and field practice.
1.9.3 Field Training & Data collection Manuals
Intensive training was given to the recruited personnel by TNS INDIA, regarding the nature of
interviews and specific skills required for eliciting data. We conducted a 8day training session for
the qualitative and quantitative teams. The training sessions was held at respective states.
Training sessions included introductory session on the study objectives, target groups,
importance of the study and implications of the study findings. The methods were used to impart
the training include lectures, discussion, role-play, demonstration interview, mock interview, field
practice interview etc.
19
1.10 Quality assurance processes adopted during baseline field survey
1.10.1 Quality assurance processes adopted during the training
The members of survey team were selected from the study states that were involved in data
collection in the previous RCH surveys and qualitative data collection.
Training on Quantitative and Qualitative questionnaires was conducted at the state level by the
senior researchers from Delhi accompanied by the field coordinators to ensure the content and
quality of training. Apart from discussing the questionnaires and other important sessions on
immunisation and newborn care practices were discussed. During the training, each question
item and the mode of administering the question were discussed.
Training was followed by 1-day field practice by the teams, which was monitored by Senior
Researcher to ensure the quality of field work and consistencies in the questionnaires.
The state level NIPI Program Officers also made special spot checks to facilitate the quality of the
training.
1.10.2 Productivity and on field scrutiny
Data collection was done by two teams; one team for the quantitative data and one for the
qualitative data. On an average 4 quantitative interviews were conducted by one member of the
Quantitative survey team in a day for this study. Similarly one member of the Qualitative data
collection team conducted 2 qualitative interviews in a day. At any given point of time of the
survey period, the interviewers did not exceed the productivity limit to ensure quality and
complete data collection.
The supervisors allotted the households to the interviewers based on the Household listing
prepared by the Listing team. All the interviews were scrutinized by the field editors and
supervisors in the village itself to check for the logical flow and consistencies in the responses.
This was done with the help of field interviewers to approach the respondents in case of any data
inconsistencies.
One field executive and one field coordinator was responsible for the data collection in each
state. The field executives visited all the teams in the first 10 days of data collection. This has
helped in identifying and plugging the initial problems and to ensure smooth and quality data
collection further.
1.10.3 Role of Supervisor
During the fieldwork, the field supervisor was responsible for planning and executing the data
collection. The supervisor was responsible in informing the block level officers and service
providers in the PSUs about the purpose of the field teams‟ visit to the place and seeks their
cooperation. This helped the field teams in conducting data collection smoothly.
If there were any issues in terms of quality or completeness of data collection by the field
executives, the supervisors immediately informed field coordinators and hence adequate
measures were taken without any delay.
1.10.4 Quality assurance visits by the central teams
The survey teams were visited by the central survey coordination team members on field to check
the process and quality of data collection.
20
1.10.5 Monitoring visits by NIPI team
Members from NIPI team (NIPI Secretariat and NIPI State Offices) visited some of the survey
teams during survey and assessed the process of data collection and completeness of data.
1.10.6 Other quality control measures
In order to control quality, we adopted rigorous checks such as spot checks, back checks and
accompaniment interviews. We adopted 10% back checks to ensure whether the correct
households were covered or not and 15% were accompanied audit norm to ensure the
questionnaire is being administered as per the instructions in the training. These were the quality
control checks adopted by supervisors, field executives and researchers during their field visits.
The field executives and researchers visited the field in such a way that one or the other was in
the field during the entire data collection period.
As a practice of quality control for any social research study the supervisor accompanied 20% of
the interviews.
“Here, we would like to mention that TNS follows the ISO 9000 standards in its data collection
procedures, which is an indication of the importance we assume to the quality of fieldwork.”
1.11 Data Processing
The hard copies of the collected forms were collected at the Central coordination office at Delhi.
All the forms were screened again for the completeness. The collected raw data was entered in
Cs Pro keeping in view the objectives of the study. Double data entry was done for 20% of the
data. The data entered were correlated with the house listing to cross check the index
candidates and also the other related parameters.
Analysis for various pre-identified indicators and other program relevant indicators was generated
in SPSS program.
The analysis was undertaken in consultation with DRS and NIPI program officers.
Table 1.5: Achieved sample

District All NIPI districts
Hoshangabad Narsimhapur Raisen
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
N N N N N N N N N N N N
PSU 35 15 50 42 8 50 41 9 50 118 32 150
# of 828 356 1184 990 212 1202 974 211 1185 2792 779 3571
women
Table 1.6: Achieved sample for facility survey
Target Group Total sample size Total achieved

per state
DH 3 3
CHC 3 9
PHC 18 17
SC 90 93
21
Table 1.7: Achieved sample for Qualitative
Target Group Research Total sample size Total achieved

Technique per state
ASHAs of the surveyed PSUs IDI 150 110
AWWs of the surveyed PSUs IDI 150 145
PRI leader IDI 150 145
VHSC IDI 150 94
ANM IDI 75 102
ANM FGD 3 3
BEE IDI 15 5
BMO IDI 15 10
CDPO IDI 15 14
LHV IDI 15 11
1.12 Report Structure
NIPI Baseline Report for Madhya Pradesh consists of 8 Chapters including this one. Chapter -2
gives Madhya Pradesh‟s household characteristics including demographic and socio economic
profile, educational level of household population and household possession. Subsequent
chapter 3 presents background characteristics of surveyed respondents which include age at
marriage and at first cohabitation, exposure to mass media and employment status of surveyed
women. Similarly chapter 4, 5, 6 & 7 presents information on maternal and child related health
indicators including information on ANC, delivery, PNC, child mortality & morbidity, and child
immunization. Chapter - 8 deals with the information on public health facility infrastructure present
in all 3 samples, which includes District hospital, Public Health Centre, Community Health Centre
and Sub Centre. All these chapters are supported by qualitative inputs and summary
observations that emerged at the time of survey.
22
Chapter 2
Household Characteristics
2.1 Household demographic profile
This section presents the demographic characteristics of the sample households across urban
and rural areas in the three districts of MP. The variables covered include age-specific distribution
of the household population by nature of the primary sampling unit as well as gender of family
member.
Table 2.1: Household population by age and sex, NIPI-08

Age MP sample districts Rural Urban
Total Male Female Total Male Female Total Male Female
% % % % % % % % %
0-4 26.3 26.5 26.2 26.4 26.2 26.5 26.3 27.4 25.2
5-9 9.4 7.3 11.4 9.6 7.4 11.6 8.9 6.9 10.7
10-14 4.7 4.1 5.2 4.7 4.3 5.1 4.5 3.6 5.4
15-19 5 4.3 5.7 5 4.2 5.8 5 4.3 5.6
20-24 12.9 7.9 17.5 12.8 8 17.3 13.3 7.7 18.5
25-29 13.3 15.2 11.4 13.1 15.3 11.1 13.7 14.9 12.5
30-34 7.3 11 3.9 7.1 10.6 3.8 8.2 12.2 4.4
35-39 3.6 5.4 1.9 3.4 5.1 1.7 4.5 6.5 2.6
40-44 2.2 2.4 1.9 2.1 2.2 2 2.4 3.2 1.7
45-49 2.6 1.9 3.2 2.7 2 3.3 2.2 1.6 2.7
50-54 3.2 3.2 3.2 3.3 3.5 3.2 2.8 2.2 3.5
55-59 3 2.5 3.4 3.1 2.6 3.7 2.5 2.3 2.6
60+ 6.5 8.3 5.1 6.7 8.6 4.9 5.7 7.2 4.6
Total 100 100 100 100 100 100 100 100 100
Total # of HH 23591 11454 12137 18628 9025 9603 4963 2429 2534
943 958 939
Consistently, the sex ratio across urban and rural areas is in favour of the female, which is
contrary to the sex ratio of MP as a whole, which stands at 920 per 1000 males (census 2001).
The possible explanation could be that the districts chosen for this survey were relatively
moderately developed ones, which are subject to out-migration, as against more developed
districts which witness large scale first generation in-migration from rural areas for employment
purposes. This thought is consistent with the fact that sex ratio is more even in the urban sample
as compared to the rural sample where the bias in favour of female members is even more
pronounced.
Table2.2: District wise age and sex distribution – Hoshangabad district, NIPI-08
Age Hoshangabad Rural Urban
Total Male Female Total Male Female Total Male Female
% % % % % % % % %
0-4 25.9 26.3 25.4 25.9 26.4 25.4 25.8 26.1 25.5
5-9 9 7 11 9.1 6.7 11.5 8.7 7.5 9.9
10-14 4.7 4.2 5.1 4.9 4.6 5.2 4 3.2 4.8
15-19 5.1 4.4 5.8 5.4 4.5 6.3 4.3 4.1 4.5
20-24 13.1 8.1 18 13.1 8.3 17.7 13.1 7.5 18.5
25-29 13.3 15 11.7 13.1 15.3 11 13.9 14.5 13.3
30-34 7.6 11.1 4.2 7 10.5 3.7 9 12.6 5.5
35-39 3.8 6 1.8 3.5 5.5 1.6 4.6 7.1 2.3
40-44 2.2 2.5 1.8 2.1 2.1 2.1 2.4 3.7 1.2
45-49 2.3 1.6 2.9 2.4 1.7 3.1 1.8 1.2 2.3
50-54 3.2 2.9 3.5 3.3 3.3 3.2 3.1 1.9 4.2
55-59 2.6 2.1 3 2.7 2.3 3.1 2.2 1.8 2.7
60+ 7.2 8.8 5.8 7.5 8.8 6.1 7.1 8.8 5.3
Total 100 100 100 100 100 100 100 100 100
Total # of HH 8018 3923 4095 5686 2783 2903 2332 1140 1192
957 958 956
23
Table2.3: District wise age and sex distribution –Narsimhapur district, NIPI-08
Age Narsimhapur Rural Urban
Total Male Female Total Male Femal Total Male Female
e
% % % % % % % % %
0-4 27.1 27.7 26.6 26.9 27.4 26.4 28.2 28.9 27.5
5-9 8.1 5.6 10.4 8.2 5.9 10.4 7.4 4.6 10.2
10-14 3.1 2.5 3.6 3 2.4 3.6 3.5 3.2 3.8
15-19 3.8 3.3 4.2 3.6 3.1 4 4.7 4.3 5
20-24 13.8 8.6 18.7 13.7 8.7 18.3 14.3 8.1 20.3
25-29 14.4 17 12 14.4 16.7 12.2 14.7 18.3 11.1
30-34 7.1 10.8 3.6 7.1 10.8 3.6 7.1 10.5 3.8
35-39 2.8 3.9 1.7 2.6 3.7 1.5 3.7 5.1 2.3
40-44 2 1.9 2 1.9 1.8 2 2.2 2.5 1.9
45-49 3.2 2.2 4.2 3.3 2.3 4.2 3 1.9 4.1
50-54 3.9 4.2 3.7 4.2 4.5 3.8 2.8 2.7 3
55-59 4.4 3.7 5 4.6 3.8 5.3 3.6 3.5 3.8
60+ 6.3 8.6 4.3 6.5 8.9 4.7 4.8 6.4 3.2
Total 100 100 100 100 100 100 100 100 100
Total # of HH 7437 3600 3837 6169 2971 3198 1268 629 639
938 929 984
Table2.4: District wise age and sex distribution –Raisen district, NIPI-08
Age Raisen Rural Urban
Total Male Femal Total Male Female Total Male Female
e
% % % % % % % % %
0-4 26.1 25.5 26.5 26.2 25 27.3 25.2 28 22.6
5-9 11 9.2 12.7 11.1 9.4 12.7 10.4 8 12.7
10-14 6.1 5.5 6.7 6.1 5.7 6.4 6.4 4.7 8
15-19 6.1 5 7.1 6 5 6.9 6.3 4.7 7.8
20-24 11.8 7.2 16.1 11.6 7 16 12.5 7.9 16.9
25-29 12.1 13.8 10.5 12 14 10.1 12.5 12.4 12.5
30-34 7.3 11 3.9 7.2 10.6 4 7.9 13 3.1
35-39 4.2 6.3 2.2 4 6.1 2 5.1 7 3.3
40-44 2.3 2.7 2 2.2 2.6 1.9 2.6 2.9 2.4
45-49 2.3 2.1 2.6 2.4 2 2.7 2.1 2.1 2
50-54 2.6 2.6 2.6 2.6 2.7 2.6 2.4 2.1 2.7
55-59 2.1 1.8 2.4 2.2 1.8 2.6 1.8 2 1.6
60+ 6 7.3 4.7 6.4 8.1 4.8 4.8 5.2 4.4
Total 100 100 100 100 100 100 100 100 100
Total # of HH 8136 3931 4205 6773 3271 3502 1363 660 703
935 934 938
The demographic trend across the three districts was very similar with 25-28% being children
below age of 5 years, 6-9% being elderly (beyond 60 years) and around 50-60% being in the
working age group of 15 – 59 years.
24
2.2 Socio-economic profile of household
This section looks at the profile of sample households in terms of type of familial structure, its
economic status as per Government of India nomenclature specified through the type of ration
card ownership, religious affinity, caste, and the number of household members.
Table 2.5: Household Composition, NIPI-08

Type of House Hoshangabad Narsimhapur Raisen Total
% % % % % % % % % % % %
Joint/extended 61.5 57.3 60.3 63.1 49.3 60.7 51.0 43.7 49.7 58.4 51.5 56.9
Nuclear 38.5 42.7 39.7 36.9 50.7 39.3 49.0 56.3 50.3 41.6 48.5 43.1
Category of household
BPL 46.0 54.8 48.6 41.7 48.8 43.0 43.8 39.1 43.0 43.7 48.9 44.9
MP experiences the culture of joint families or extended across the programme districts. The only
exception to the trend is the district of urban Raisen where, in percentage terms, the situation is
almost reverse.
As far as economic categorization was concerned, it was verified through the type of ration card
given to a particular household whether or not the same falls under Below Poverty Line category
or otherwise. Assuming true BPL households would be quite categorical in ensuring that they do
own a BPL identity card/ration card for the simple reason that the ensuing benefits in the present
political regime is far too lucrative, the poverty rate in the three districts combined stands at 44.9
The relatively more backward district in that sense is
Hoshangabad with the highest poverty rate while Raisen and Narsimhapur appears to be
relatively more developed. Consistently, the rural poverty rate is more that of its urban
counterpart. The only exception is Narsimhapur where the urban poverty is more than then the
rural.
Table 2.6: Household Composition, NIPI-08

Type of House Hoshangabad Narsimhapur Raisen Total
% % % % % % % % % % % %
Religion
Hindu 98.2 89 95.4 96 83.7 93.8 92.9 78.6 90.4 95.6 84.7 93.2
Muslim 1.5 9.9 4.1 3.8 14.9 5.7 6.9 20 9.2 4.2 14 6.3
Sikh 0
0 0.3 0.1 0 0 0 0 0.9 0.1 0.3 0.1
Christian
0.1 0.3 0.2 0.2 0.2 0.1 0.5 0.1 0.1 0.1 0.1
Jain 0.2 0.5 0.2 0 0.5 0.1 0.1 0 0.2 0.1 0.5 0.2
Other 0 0 0 0 0.9 0.2 0 0 0 0 0.4 0.1
Caste/Tribe
SC 23.1 34.2 26.4 7.2 13.6 8.3 19.1 18.1 18.9 16.1 24.2 17.9
ST 20.5 9.7 17.2 12.3 4.7 11.0 19.4 4.7 16.8 17.2 7.0 15.0
OBC 46.6 41.1 44.9 68.4 63.6 67.5 42.6 43.7 42.8 52.9 47.9 51.8
General 9.8 15.0 11.4 12.0 18.2 13.1 18.9 33.5 21.5
Mean 6.8 6.4 6.7 6.1 5.9 6.1 6.8 6.3 6.8 6.6 6.3 6.5
Total # of HH 840 363 1203 1004 215 1219 990 215 1205 2834 793 3627
Overwhelmingly, almost all the sample households were of Hindu faith, with a 6% share of
Muslim households only in urban programme districts. Other Backward Communities (OBC) and
General castes (GC) were the dominant social groups accounting for 51% and 22% of the
households respectively. The third major social group was Schedule Castes with the Schedule
Tribes being a relative minority in these districts.
The average household size varied between 6.8 in rural Raisen to 5.9 in urban Narsimhapur.
25
Table 2.7: Household family size by religion, NIPI-08

Hoshangabad Narsimhapur Raisen All districts
Rural Urban Rural Urban Rural Urban Rural Urban
Religion N Mean N Mean N Mean N Mean N Mean N Mean N Mean N Mean

Hindu 825 6.8 323 6.4 964 6.1 180 5.7 920 6.9 169 6.3 2,709 6.6 672 6.2
Muslim 13 7.6 36 6.4 38 6.8 32 7.1 68 6.6 43 6.5 119 6.8 111 6.6
Christian 1 7 1 8 2 6.5 0.0 0.0 1 5 0.0 0.0 4 6.3 0.0 0.0
Jain 1 4 1 9 0.0 0.0 1 4 1 7 1 5 2 5.5 0.0 0.0
Sikh 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2 4.5 0.0 0.0 2 6.5
Others 0.0 0.0 0.0 0.0 0.0 0.0 2 5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
By religion, average family size of Jain varied between 9.0 in urban Hoshangabad to 4.0 in urban
Narsimhapur while for Christians, average family size varied between 8.0 in urban Hoshangabad
to 5.0 in rural Raisen.
2.3 Education level of the household population
The level of educational attainment of different members of the households (starting with the age
of 5 years) has been analyzed on the basis of location of the PSU and gender of the household
member. The findings are presented below.
Table 2.8: Education attainment by gender of household member versus years of schooling, NIPI-08
Hoshangabad Narsimhapur Raisen State Total

Male Female Total Male Female Total Male Female Total Male Female Total
Years of % % % % % % % % % % % %
schooling
No
schooling 23.7 41.6 32.9 32.1 48.4 40.6 28.2 42.5 35.5 27.8 44 36.2
< 5 years
complete 13.4 15.9 14.7 9.8 12.7 11.3 13.5 17.5 15.6 12.3 15.4 13.9
5-7 years
complete 19 17.5 18.2 17 17.2 17.1 18.4 18 18.2 18.2 17.5 17.9
8-9 years
complete 16.9 13.4 15.1 18.8 13.5 16.1 20.1 13.7 16.8 18.6 13.6 16
10-11
years
complete 12.4 5.6 8.9 11.6 4.6 8 10.9 4.5 7.6 11.6 4.9 8.2
12 or
more
years
complete 14.6 6 10.2 10.7 3.6 6.9 8.9 3.8 6.3 11.5 4.6 7.8
Total 100 100 100 100 100 100 100 100 100 100 100 100
Total # of 2890 3053 5943 2603 2816 5419 2927 3089 6016 8420 8958 17378
members
Consistently across all districts, illiteracy was higher among females. It may also be noted that
even though the level of illiteracy was lowest in Hoshangabad district (it may be recalled that it
also had the highest development profile), the differences between genders is most stark in this
district.
Overall, illiteracy was around 29% and the proportion of persons having completed their basic
education (at least 10years) was 48%.
Women members having completed their secondary level of education (10 years or more) were
proportionately higher in Raisen (50%) as against Narsimhapur (44%) or Hoshangabad (48%).
26
Table 2.9: Education attainment by location of PSU in terms of years of schooling , NIPI-08

Years of % % % % % % % % % % % %
schooling
No schooling 37.3 22 32.9 43.2 27.3 40.6 37.4 26.1 35.5 39.3 24.5 36.2
< 5Years
complete 14.6 14.9 14.7 11.3 11.5 11.3 16.1 13.1 15.6 14 13.5 13.9
5-7 Years
complete 17.8 19.3 18.2 16.4 20.4 17.1 18.2 18.5 18.2 17.5 19.4 17.9
8-9 Years
complete 14.4 16.6 15.1 15.9 16.8 16.1 16.7 17.5 16.8 15.7 16.9 16
10-11 Years
complete 8.2 10.7 8.9 7.4 10.7 8 6.8 11.4 7.6 7.4 10.9 8.2
12 or more
years
complete 7.7 16.5 10.2 5.8 13.3 6.9 4.8 13.4 6.3 6.1 14.8 7.8
Total 100 100 100 100 100 100 100 100 100 100 100 100
Total # of 840 363 1203 1004 215 1219 990 215 1205 2834 793 3627
members
As expected, illiteracy was consistently higher in the rural areas of all three districts as against
their urban counterpart. Overall, 39% of the members of the rural sample households had no
formal schooling while this was much lower in the urban areas (25%).
2.4 Household characteristics
This section elucidates the nature of the sampled households by issues pertaining to
environmental sanitation and hygiene. The parameters considered include type of housing,
sources of drinking water, method of storage of drinking water, water treatment, availability of
toilet facility, nature of fuel used for cooking, availability of a chimney in the kitchen and whether
the house has a separate room for cooking as against cooking being done within the confines of
the residential quarters.
Table 2.10: Type of house, NIPI-08

Indicator Semi Total No. of
Kaccha Pucca Total
Kaccha HH
Rural 28.2 58.5 13.3 100 840
Hoshangabad Urban 16.8 50.7 32.5 100 363
Total 24.8 56.1 19.1 100 1203
Rural 35 48.6 16.4 100 1004
District Narsimhapur Urban 19.5 50.2 30.3 100 215
Total 32.2 48.9 18.9 100 1219
Rural 35.4 51.7 12.9 100 990
Raisen Urban 23.3 39.1 37.6 100 215
Total 33.2 49.5 17.3 100 1205
Rural 33.1 33.1 52.6 14.3 2834
MP Urban 19.3 19.3 47.4 33.3 793
Total 30.1 30.1 51.5 18.4 3627
Rural 71.6 71.6 63.6 8 51419
MP (DLHS 3) Urban 26.1 26.1 37.6 51.7 11699
Total 61.2 61.2 28 18.4 51419
27
As expected, the majority of the houses in rural areas were of semi kaccha construction (non-
permanent nature of walls, floor and roof) while the situation was the reverse for urban locations.
The practice of having any one or two of the three basic components made of permanent
construction materials seems to be quite prevalent, especially in urban Raisen and urban
Hoshangabad, where over a third of the sample lived in such houses.
Overall, DLHS3 data shows higher percentage of 61% living in Kaccha housing while NIPI survey
reports with only 19% living in kaccha housing, it may be safely concluded that the sample drawn
from across the three districts was affluent in nature
Table 2.11: Source of drinking water, NIPI-08

Indicator District State Total
Piped into dwelling % % % % % % % % % % % %
Piped to yard 3.2 11.8 5.8 7.1 30.2 11.2 2.4 20.5 5.6 4.3 19.2 7.6
Public tap 4.3 21.2 9.4 1.4 10.2 3 1.6 12.6 3.6 2.3 15.9 5.3
Tube well 8.8 32.2 15.9 8.6 38.1 13.8 7.9 28.8 11.6 8.4 32.9 13.8
Protected well 57.5 24.8 47.6 78.7 19.5 68.3 72.2 37.2 66 70.1 26.7 60.7
Unprotected well 7.6 3.3 6.3 0.7 0.9 0.7 4.6 3.8 4.1 1.8 3.6
Protected spring 16 3.6 12.2 2 0.9 1.8 9.3 0.5 7.7 8.7 2 7.2
Unprotected spring 0.2 0.8 0.4 0.1 0 0.1 0 0 0 0.1 0.4 0.2
Rain water 1 0.3 0.7 0.4 0 0.3 0.4 0 0.3 0.6 0.1 0.5
Surface water 0 0 0 0.1 0 0.1 0 0 0 0 0 0
Other 1 1.1 1 0.7 0.2 0.6 1.5 0 1.2 1.1 0.5 1
Piped into dwelling 0.4 0.9 0.7 0.2 0 0.1 0.1 0.4 0.2 0.3 0.5 0.1
Total 100 100 100 100 100 100 100 100 100 100 100 100
Total # of HH 840 363 1203 1004 215 1219 990 215 1205 2834 793 3627
…I am the PRI representative here…it is my Majority of the households depended on

job to look after cleaning of drains…arrange protected wells for their drinking water in rural
for funds to repair ad make roads…there is areas, especially in Narsimhapur and Raisen.
lot of work in digging wells…drinking water Another, segment living in rural Hoshangabad
is a problem…we use NRHM funds to (19%) and Narsimhapur (10%) actually sourced
undertake sanitation and road building their drinking water from protected spring. In
work… - Bhuri Bai Patel, female Corporator, urban areas, more options were available and it
Mard no. 13, Gotegaon, Narsinghapur was observed that people had access to tube
well and public tap water within residential
compound. The piped water facility seems to be most developed in Narsimhapur district, followed
by Raisen. It has yet to be made available in a significant way in Hoshangabad.
28
Table 2.12: Drinking water storage and filtration practices

% % % % % % % % % % % %
Usual method of storage of drinking water
Covered Bucket 87.1 87.6 87.3 76.0 82.8 77.2 64.8 67.0 65.2 75.4 80.7 76.6
Covered Earthen
12.6 11.8 12.4 23.4 17.2 22.3 34.0 31.6 33.6 23.9 18.7 22.8
Pot
Open Container 0.2 0.0 0.2 0.4 0.0 0.3 0.5 0.5 0.5 0.4 0.1 0.3
Open Bucket 87.1 0.6 0.2 0.2 0.0 0.2 0.4 0.3 0.2 0.3 0.2
Others 12.6 0.0 0.0 0.0 0.0 0.0 0.2 0.9 0.3 0.1 0.3 0.1
Method adopted to make water safer to drink*
Boil 1.2 3.6 1.9 2.6 8.4 3.6 2.2 10.7 3.7 2.0 6.8 3.1
Use Alum 0.1 0.0 0.1 0.0 0.0 0.0 0.0 1.9 0.3 0.0 0.5 0.1
Add Bleach/ 6.5 5.8 6.3 0.4 2.8 0.8 0.9 5.1 1.7 2.4 4.8 2.9
Chlorine Tablets
Strain Through a 35.2 55.4 41.3 11.7 33.5 15.5 29.2 47.0 32.4 24.8 47.2 29.7
Cloth
Use Water Filter 0.4 0.8 0.5 0.1 2.8 0.6 0.1 0.9 0.2 0.2 1.4 0.4
(Ceramic/Sand/
Composite/ etc.)
Use Electronic 0.1 0.0 0.1 0.1 1.9 0.4 0.0 0.0 0.0 0.1 0.5 0.2
Purifier
Let it Stand and 0.0 0.0 0.2 0.5 0.2 0.0 0.0 0.0 0.1 0.1 0.1
Settle
Other 0.7 1.1 0.8 1.1 2.8 1.4 0.5 0.5 0.5 0.8 1.4 0.9
Do not treat/filter 45.2 34.9 51.1 84.8 48.9 78.9 68.2 34.5 62.5 70.6 38.6 63.7
Total # of HH 840 363 1203 1004 215 1219 990 215 1205 2834 793 3627
* Multiple response questions
The usual method of storage of drinking water was in a covered vessel (bucket or earthen pot).
This was consistent across all three districts. Correct storage practice was observed to be
relatively higher in urban areas than rural.
The most common filtration/purification process was strain through cloth, whether it is urban or
rural locations. Another process practiced for purification was boiling water. While in urban areas
of all the programme districts, there is a practice of using chlorine tablets or add bleach
However, what is perhaps more important to understand is that the majority across all three
districts did not do anything to filter or treat the drinking water that they store and consume. The
situation is worse in rural households of Narsimhapur and Raisen (70-80%).
29
Table 2.13: Sanitation facility, NIPI-08

Indicator District
State Total
% % % % % % % % % % % %
Flush to Piped 13.9 44.1 23 11.9 40.5 16.9 11.3 41.9 16.8 12.3 42.5 18.9
Sewer System
Flush to Septic 9 9.6 9.2 4.5 1.4 3.9 1.4 8.4 2.7 4.8 7.1 5.3
Tank
Flush to Pit 3.2 1.1 2.6 0 0 0 0 0 0 1 0.5 0.9
Latrine
Flush to 0 0 0 0 0 0 0.2 0 0.2 0.1 0 0.1
somewhere else
Flush Don't know 0 0 0 0 0 0 0 0.5 0.1 0 0.1 0
Ventilated 4.4 6.1 4.9 6.6 7.4 6.7 6.9 7 6.9 6 6.7 6.2
improved pit
Pit latrine with 0.4 0 0.2 2.9 4.2 3.1 1.5 6 2.3 1.7 2.8 1.9
slab pit
Pit latrine without 0.7 0 0.5 0.4 0.5 0.4 0 0 0 0.4 0.1 0.3
slab
Twin Pit 0.2 0 0.2 0 0 0 0 0 0 0.1 0 0.1
Dry toilet 0 0 0 0 0.5 0.1 0 0 0 0 0.1 0
No Facility 68.1 38.3 59.1 73.1 39.1 67.1 78.4 35.8 70.8 73.5 37.8 65.7
Public Facility 0 0.8 0.2 0.6 6.4 1.7 0.3 0.4 0.2 0.1 2.3 0.6
Other 0.1 0 0.1 0 0 0.1 0 0 0 0 0 0
Total 100 100 100 100 100 100 100 100 100 100 100 100
Total # of HH 840 363 1203 1004 215 1219 990 215 1205 2834 793 3627
According to DLHS3 nearly 77.4 % of households had …a major part of my work is to get „toilets‟
reported that they had no access to toilet facility. made…I use funds at my disposal to look
Similarly 65% of the households had reported that they after sanitation of the village…I have to raise
did not have access to a toilet facility, implying that open the awareness levels of the people regarding
defecation was the prevalent practice in these three health and hygiene… - Pawel Sarathe,
districts. Overall there was a significant availability of secretary Gram Panchayat, village Barhata,
flush to piped sewer system (19%) with urban showing Gotegaon, Narsinghpur
better coverage (43%) than rural areas (12%) in the
state
Table 2.14: Cooking environment, NIPI-08

Fuel used for cooking
Electricity 0.2 0.3 0.2 0 0 0 0 0 0 0.1 0.1 0.1
LPG 5.4 30.3 12.9 2.7 30.2 7.5 3.1 27.4 7.5 3.6 29.5 9.3
Biogas 0.2 0 0.2 0.4 0 0.3 0.3 1.9 0.6 0.3 0.5 0.4
Kerosene 0 2.2 0.7 0.2 1.9 0.5 0.1 3.3 0.7 0.1 2.4 0.6
Coal 0.1 0.3 0.2 0 0 0 0.1 0 0.1 0.1 0.1 0.1
Charcoal 3.1 7.2 4.3 0.1 0.5 0.2 4 0 3.3 2.4 3.4 2.6
Wood 86.3 59 78.1 92.9 66 88.2 70.2 60 68.4 83 61.2 78.2
Dung 4.5 0.6 3.3 3.7 0.9 3.2 22 7.4 19.3 10.3 2.5 8.6
Agricultural waste 0.2 0.1 0.1 0 0.5 0.1 0.2 0 0.1 0.1 0.3 0.1
Cooking done under a chimney
Yes 9.4 4.7 8.0 3.3 3.3 3.3 3.0 3.7 3.2 5.0 4.0 4.8
No 90.6 95.3 92.0 96.7 96.7 96.7 97.0 96.3 96.8 95.0 96.0 95.2
Separate room used as a kitchen
Yes 71.5 70.5 71.2 48.9 60.5 50.9 56.7 53 56 58 63 59
No 28.5 29.5 28.8 51.1 39.5 49.1 43.3 47 44 42 37 41
Total 100 100 100 100 100 100 100 100 100 100 100 100
Total # of HH 840 363 1203 1004 215 1219 990 215 1205 2834 793 3627
30
Firewood was the most commonly used cooking fuel followed by dung across the rural areas of
all three districts while in the urban areas; LPG is the most commonly used fuel for cooking.
Less proportion of charcoal is used in Hoshangabad and Raisen (about 4%) followed by
kerosene usage in urban Hoshangabad and Raisen.
As far as cooking under a chimney was concerned, the concept just did not exist in any of the
study districts.
Overall, and separately for the three districts individually as well, there was a separate kitchen in
around half of the urban locations. The same was around 63% in the urban households, implying
that in the rural households, the inhabitants were at a higher risk of suffocation and RI resulting
from the cooking smoke than the urban households.
2.5 Household possessions

This section primarily deals with ownership status of the place of residence, main occupation of
earning members, ownership of agricultural land, allied information on financial inclusion, viz.
bank and health insurance access and finally, household level asset ownership.
Table 2.15: Ownership of immovable assets, NIPI-08

% % % % % % % % % % % %
House owned or rented
Own 95.1 86.0 92.4 97.7 85.6 95.6 93.5 73.0 89.9 95.5 82.3 92.6
Rented 4.9 14.0 7.6 2.3 14.4 4.4 6.5 27.0 10.1 4.5 17.7 7.4
Ownership of Agricultural land
Yes 47.5 13.5 37.2 39.5 5.6 33.6 42.7 18.1 38.3 43.0 12.6 36.4
No 52.5 86.5 62.8 60.5 94.4 66.4 57.3 81.9 61.7 57.0 87.4 63.6
Total 100 100 100 100 100 100 100 100 100 100 100 100
Total # of HH 840 363 1203 1004 215 1219 990 215 1205 2834 793 3627
Nearly all residents of rural areas lived in their own house (owner occupancy was as high as
95%). In urban areas, the rental concept is more pronounced and around 17% people did live on
rent. The trends are very similar across Hoshangabad and Narsimhapur, with Raisen having
more people staying on rent than the rest.
Table 2.16: Main source of household income, NIPI-08
Indicator District
State Total
Rural Urban Tota Rural Urban Tota Rural Urban Tota Rural Urban Tota
l l l l
% % % % % % % % % % % %
Farming/ 28 4.1 20.8 26.8 2.3 22.5 29.6 7.4 25.6 28.1 4.5 23
cultivation
Agri. labour 36.4 3.6 26.5 39.3 4.7 33.2 26.8 14 24.5 34.1 6.7 28.1
Allied primary 0.8 0.6 0.7 0.5 0.9 0.6 3.4 7 4.1 1.6 2.4 1.8
sector activities
Manufacturing 0 0 0 0.8 0.5 0.7 0.6 0.5 0.6 0.5 0.3 0.4
Construction 0 0.6 0.2 0.1 0.9 0.2 2.1 13.5 4.1 0.8 4.2 1.5
Petty Trader 1 5.2 2.2 3.1 19.1 5.9 4 2.8 3.8 2.8 8.3 4
Artisan 4.3 12.1 6.7 3.2 13.5 5 4.4 11.6 5.7 4 12.4 5.8
Business 0.4 2.3 0.3 1.7 3.7 2.1 0.9 1.9 1.1 1 1.6 1.2
Salaried job 2.3 9.1 4.3 1.9 9.8 3.3 2.3 4.2 2.7 2.2 7.9 3.4
Other labour 5.1 24.3 9.8 2.8 22.1 5.5 6.3 20 8.5 4.7 19.5 8
Others 21.7 38.1 28.5 19.8 22.5 21 19.6 17.1 19.3 20.2 32.2 22.8
Total 100 100 100 100 100 100 100 100 100 100 100 100
Total # of HH 840 363 1203 1004 215 1219 990 215 1205 2834 793 3627
31
In the rural areas of all three districts, agricultural labour accounted for the main income source
for not more than a quarter of the households.
The situation is similar here as well. Next to

…there is problem of transportation…people
cultivation, 28 % of rural households had can not afford ambulance…they can arrange
reported that their main source of livelihood was for bullock cart or tractor…I have to arrange
farming cultivation and other activities, and if for transportation… - Dharmendra Singh
one considers most jobs in self-business it Raghuvansh, Panchayat Member, village
would be petty traders and artisans. Like the rest Bardha Bamhori, Silvani, Raisen
of India, only around 3% of the families were
securing their earning from salaried
employment. The trends are quite similar across
all the three study districts.
In the urban areas, there is a preponderance of salaried employment across both public and
private sectors (to the tune of nearly 8%).
Construction of Wealth Index – Madhya Pradesh
We have considered the data records of all the women in the state. The selected assets/
indicators for the construction of index are:( Annexure A1)
1. Toilet used
2. Fuel used for cooking
3. Ownership of Mattress
4. Ownership of Mosquito net
5. Ownership of Chair
6. Ownership of Table
7. Ownership of Pressure cooker
8. Ownership of Radio/ transistor
9. Ownership of Watch or clock
10. Ownership of Sewing machine
11. Ownership of Electricity
12. Ownership of Electric fan
13. Ownership of Television
14. Ownership of Refrigerator
15. Ownership of Computer
16. Ownership of Mobile phone
17. Ownership of Land phone
18. Ownership of Water pump
19. Ownership of Thresher
20. Ownership of Tractor
21. Ownership of Car/ Jeep
22. Ownership of Two wheeler/ Four wheeler
23. Ownership of Bus/ truck
24. Ownership of Cot/ bed
25. Ownership of Bicycle
26. Ownership of animal drawn chart
32
Calculation Procedure:
The first 2 indicators are derived from collected information from the available information as
follows:
a) Toilet facility used – If a household is having an improved toilet facilities then it is given a
score 1, otherwise it is given a 0 score.
b) Fuel used for cooking – If a household is using modern forms of fuel for cooking
purposed then the household is awarded a score of 1, otherwise it is given a 0 score.
The next 24 indicators are considered directly from the ownership. If a household has that
particular asset then it is given a score of 1 for that asset, otherwise 0.
This procedure first standardizes the indicator variables (calculating z-scores); then the factor
coefficient scores (factor loadings) are calculated; and finally, for each household, the indicator
values are multiplied by the loadings and summed to produce the household‟s index value. In this
process, we used only factors of first component. The resulting sum is itself a standardized score
with a mean of zero and a standard deviation of one. Using these 26 reconstructed variables we
have carried out Principal component analysis. In the process of PCA we have dropped 6
variables due to their low or negative effect on index. Based on the remaining 20 variables, in the
Principal component analysis the components with eigen values greater than 1 are explaining a
variation of around 52.6% in the data, with the first component explaining 34% of variation.
Wealth index quartiles Percent of women

Quintile 1 48.6
Quintile 2 14.0
Quintile 3 12.2
Quintile 4 11.9
Quintile 5 13.3
Total 100
The proportion of households belonging to each quintile, across urban and rural areas of the
three districts is as follows:
Table 2.17: Household Wealth Index, NIPI-08
Wealth Index District

State Total
% % % % % % % % % % % %
Lowest 46.3 20.9 38.7 65.3 33.5 59.7 52.2 24.7 47.3 55.1 25.3 48.6
Second 16.3 13.8 15.5 10.7 14 11.2 15.8 13.5 15.4 14.1 13.7 14
Middle 10.5 19.3 13.1 9.6 11.6 9.9 12.9 16.3 13.5 11 16.4 12.2
Fourth 12.4 17.4 13.9 7.7 21.4 10.1 10 19.1 11.6 9.9 18.9 11.9
Highest 14.5 28.6 18.8 6.7 19.5 9.1 9.1 26.4 12.2 9.9 25.7 13.3
Total 100 100 100 100 100 100 100 100 100 100 100 100
Total # of HH 840 363 1203 1004 215 1219 990 215 1205 2834 793 3627
In terms of asset ownership by households, it may be observed that the majority of the
households in the rural areas belonged to the lowest quintile (45-55%) while it was more or less
the reverse in the urban areas (with 20-30% in the highest quintile). In line with what we had
observed regarding the poverty rate, here too the households of Hoshangabad appeared to be
more affluent than either Raisen or Narsimhapur.
33
Table 2.18: Bank account, NIPI-08
Indicator District
State Total
% % % % % % % % % % % %
Member having bank account
Yes 24.3 31.2 26.4 13.1 24.2 15.1 16.4 27.9 18.4 17.6 28.4 19.9
No 73.8 66.9 71.7 85.7 73.9 83.6 81 69.8 79 80.5 69.6 78.2
DK 1.9 1.9 1.9 1.2 1.9 1.3 2.6 2.3 2.6 1.9 2 1.9
Total 100 100 100 100 100 100 100 100 100 100 100 100
Any member covered with insurance
Yes 2.4 18.8 4.3 1.5 14.7 6.1 7.1 8.4 7.5 3.7 12.9 6
No 96.8 78.3 94.7 96.9 84.1 92.4 92.2 91 91.9 95.3 86 93
DK 0.8 2.9 1 1.6 1.2 1.5 0.7 0.6 0.6 1 1.1 1
Total 100 100 100 100 100 100 100 100 100 100 100 100
Total # of HH 840 363 1203 1004 215 1219 990 215 1205 2834 793 3627
In India, the overall banking penetration as on 2007 was 44%. The situation in the study districts
was even worse with only 20% of households had any member with a bank account. Bank
penetration was relatively higher in Hoshangabad district as compared to the others.
Across all three districts, insurance coverage was very low, even in the urban areas. Among
those who were covered, the significant contributor seems to have been ESI coverage and other
Privately Purchased Commercial (AnnxureA2)
Funds Allocation and Utilisation
Details regarding funds allocated and utilized for …there is one ASHA working in our
village…I got the form filled up for
different activities under NRHM are presented
ASHA…got it sanctioned from government
authorities…funds is a problem…2006-07
In Hoshangabad district, 26 percent of total budget for and 2007-08 funds have been irregular… -
2007-2008 was utilized. in case of child health care. Khuwan Singh Shilpi, village Dhilwad, Bareli,
Raisen
A total of 95 percent of funds were utilized in case of
infrastructure and human resources across the state. In Hoshangabad, only 6 percent of funds
were utilized for infrastructure and human resource while in Raisen 41 percent funds were
utilized.
A total of 22 percent of funds were utilized in training across the state. For Hoshangabad only 5
percent of funds for training were utilized, while in Raisen district, 15 percent of funds were
utilized.
About 78 percent of the allocated funds were utilized in maternal health including JSY.
Approximately 20 percent of total budget for maternal health and JSY in Hoshangabad was
utilized while in Raisen only 23 percent of total funds for maternal health and JSY were utilised.
34
Summary observation
The three districts have three distinct profiles

 Narsimhapur as reported as primarily a rural district with lowest level of literacy in urban and
rural both.
 This district was found to have most remote villages where accessibility was impinging on
delivery of health services.
 Raisen and Hoshangabad was the districts reported to be nearest to state capital
 This district was reportedly in
…two years back a VHSC was made in the comparison most “urbanized”
village…woman PRI member, ASHA and AWW were  There was consequently
the members…what happened after that I do not concentrations of semi-urbanized
know…there are the usual problems of sickness in
„slum‟ settlements
small children…roads and drinking water problem…I
help the AWW…I go and convince mothers who do  Narsimhapur district in contrast
not let their babies to be weighed…mothers who do to the above two was most remote
not get their children immunized.. – Santosh Meena, from state capital
Sarpanch, PRI Head, village Muktapur, Sachi, Raisen  Hoshangabad district was
centered around traditional „wholesale‟
market town complex
 Hoshangabad district also was traditionally a „railway‟ junction area, well connected by rail
and road to neighboring states and other parts of India
 This district was relatively more „urbanized‟ than other two intervention districts.
35
Chapter 3
Characteristics of Survey Respondents
3.1 Background characteristics
This section provides details of the background characteristic of the eligible women (currently
married women, who delivered babies in last two years, aged 15-49) who were part of the survey
process. The section looks at their demographic and social characteristics in terms of age,
religion, ethnicity, number of years of schooling and education of husband.
Table 3.1: Age distribution of women respondents, NIPI-08
District
Total
Age Group % % % %
15-18 1.7 1.6 4.1 2.4
19-21 22.7 26 22.7 23.8
22-25 44.3 48.3 39.4 44
26-30 23.4 18.5 24.7 22.2
31-40 7.8 5.4 8.4 7.2
41-49 0.1 0.2 0.7 0.4
Number of women 1184 1202 1185 3571
Almost all of the interviewed women were in the age bracket of 19 – 30 years. Very few (2%)
were actually at or below the legal age of marriage. Less than 8% of the sample consisted of
currently married women aged above 30 years.
Table 3.2: Religion and ethnicity, NIPI-08
District
Total
Religion % % % %
Hindu 99.7 97.0 97.1 97.9
Muslim 0.1 2.2 1.2 1.2
Sikh 0.1 0.3 0.2 0.2
Christian 0.0 0.5 1.5 0.7
Other 0.1 0.0 0.0 0.0
Caste/tribe
Schedule Caste 26.5 8.3 18.7 17.8
Schedule Tribe 17.3 11.0 16.7 15.0
OBC 44.6 67.7 43.2 51.9
General caste 11.5 13.1 21.4 15.3
Number of women 1184 1202 1185 3571
The eligible women interviewed were almost entirely of Hindu faith. They were mostly from OBC
families (51.9%) or SC (17.8%). Less than one fifth (15%)of families were STs and of general
castes.
36
Table 3.3: Education status of women respondents, NIPI-08
District
Total
Education (Years of Schooling) % % % %
No education 38.1 44.4 41.5 41.4
<5 5.5 3.8 5 4.8
5-7 20.5 19.8 22.7 21
8-9 18.4 19.8 19.5 19.2
10-11 8.3 6.7 5.7 6.9
12 & Above 9.2 5.5 5.6 6.7
Number of women 1184 1202 1185 3571
Female literacy was highest in Hoshangabad (61.9%) and lowest in Narsimhapur (58.5%).
However, it must be said that these percentages are far above the all India average. Majority of
th
the women in our survey sample seem to have educated beyond primary level (5 grade) but not
th
completed secondary education (10 grade). Around 47% of the sample in Raisen had received
at least 10 years of formal education while this was 44% in case of Hoshangabad and around
43% for Narsimhapur district. The district wise relationship between education and age of
respondent has been provided in Annexure Table A3.
The husbands were far more educated than their spouses with average literacy being 77.8%
(both read and write).
3.2 Exposure to mass media
The following section explores the extent to which the target population has access to various
mass media sources, the frequency of access and the types of programs that are preferred. This
section also looks at the extent to which maternal and child care messages have been sourced
from the media as well as inter personal contacts during social events, the level of acceptability of
these messages and the impact of the same on behaviour.
This section looks at media habits of the respondents in terms of readership, listenership and
viewership. It also looks at frequency of exposure by key background variables viz. age of
respondent, their completed level of education, and finally, by their family‟s position in the
Household Wealth Index.
Table 3.4: Media habits, NIPI-08

Hoshangabad Narsimhapur Raisen All districts
Rura Urba Tota Rura Urba Tota Rura Urba Tota Rura Urba Tota
l n l l n l l n l l n l
% % % % % % % % % % % %
Read the 34.1 46.8 39.9 11.5 36.1 17.2 30.1 47.8 34.2 25 44.3 30.4
newspaper*
Listen to the radio 13.3 12.6 13.1 5.5 9.4 6.2 20.8 37.4 23.8 13.1 18.5 14.3
Watch TV 59.9 83.4 67 41.6 72.6 47.1 56.9 84.4 61.8 52.4 80.7 58.6
Exposure to cinema 1.4 5.3 2.6 1.2 6.1 2.1 1.4 9.0 2.8 1.4 6.5 2.5
* Among those who can read
Overall, about 30% of the women read newspaper, out of which very few percentage read
newspaper every day. This was much lower if one looks only at the rural areas. As far as radio
listernership was concerned, the situation is even worse, with only 14% women listening to the
radio. This is very much in line with the NRS 2006 findings.
37
On the other hand, television viewer ship enjoys by far the largest penetration among the women
respondents with 58.6% women reporting that they watch television, out of which about 30 %
watch it regularly. This is as high as 80.7% in urban areas and nearly 52.4% in rural areas.
Television thus emerges as the most viable communication medium for outreach in the study
districts. Here it may be stated that the exposure to either of the media was positively correlated
with the Household Asset Index status of the household in which the women live.
It is quite clear that the culture of going out to watch a movie did not exist in any of the three
districts, even in the urban areas. Hence, this does not present itself to be a suitable medium to
be used for communication purposes.
Table 3.5: Frequency of exposure, NIPI-08
Almost At least Less than a Not at all Total

every day once a week week
Frequency of reading
100
newspaper and magazine 5.3 10.7 18.4 65.6
Frequency of listening to
100
the radio 4.5 2.9 6.9 85.7
Frequency of watching
100
television 29.7 7.1 21.8 41.4
We had already seen that even among literates, the practice of reading a newspaper or magazine
was limited with 69.6% claiming not to be doing so.
Radio listener ship was again rather infrequent with 85.7% stating they do not listen to the radio
at all. Only television viewers seem to be accessing this medium with the degree of regularity
(29.7 % watch almost every day) required for making this a viable alternative channel for
communicating key health messages. (Annexure 4, 5, 6)
3.3 Employment Status
Out of the 1184 interviewed women in Hoshangabad district, only 228 (or 19%) had any
independent source of income. In line with the age distribution of the sample in Hoshangabad
district, most of these women were between 22 – 30 years of age (68.9)
Similarly, out of the 1202 interviewed women in Narsimhapur district, only 195 (or 16%) had any
independent source of income. In line with the age distribution of the sample in Narsimhapur
district, most of these women were between 19 – 30 years of age (89%).
Finally, out of the 1185 interviewed women in Raisen district, 283 (or 24%) had any independent
source of income. In line with the age distribution of the sample in Raisen district, most of these
women were between 22 – 30 years of age (59%).
38
Table 3.6: Employment status of eligible women by background characteristics, NIPI-08

Hoshangabad Narsimhapur Raisen Total
Any source of income Any source of income Any source of income Any source of
income
Yes Yes Yes Yes Yes Yes Yes Yes
Age Group N % N % % % % %
15-18 1 0.4 4 2.1 12 4.2 17 2.4
19-21 40 17.5 51 26.2 62 21.9 153 21.7
22-25 93 40.8 73 37.4 87 30.7 253 35.8
26-30 64 28.1 51 26.2 80 28.3 195 27.6
31-40 30 13.2 15 7.7 38 13.4 83 11.8
41-49 0 0 1 0.4 4 1.5 5 0.7
Total No. of earning 228 100 195 100 283 100 706 100
women
Years of schooling
No education 140 61.4 114 58.5 170 60.1 424 60.1
Below 5 9 3.9 7 3.6 14 4.9 30 4.2
5-7 37 16.2 33 16.9 55 19.4 125 17.7
8-9 20 8.8 29 14.9 31 11 80 11.3
10-11 8 3.5 3 1.5 5 1.8 16 2.3
12 & above 14 6.2 9 4.6 8 2.8 31 4.4
Total No. of earning 228 100 195 100 283 100 706 100
women
The second part of this table needs to be interpreted in conjunction with Table 3.3. It may be
recalled that overall, 41.4% of the responding women were illiterate. However, these 41.4%
accounted for 60% of the total number of earning women in the sample. Again, 19% of the
th
sampled women were educated till their 10 standard and beyond. But, this relatively highly
qualified segment contributed to only 11% of the total earning women in the sample. This analysis
clearly implied that in districts of MP, the propensity to work and earn is not a function of
educational attainment and qualifications, but rather other compulsions such as hunger and
poverty. (Annexure A7)
Table 3.7: Membership in SHGs and mahila mandals, NIPI-08
Member of any SHG/Mahila Mandal

Indicator Hoshangabad Narsimhapur Raisen Total
% % % % % % % % % % % %
Yes 4.5 2.8 4.0 1.4 0 1.2 4.2 1.9 3.8 3.3 1.8 3.0
No 95.5 97.2 96.0 98.6 100 98.8 95.8 98.1 96.2 96.7 98.2 97.0
Total 828 356 1,184 990 212 1,202 974 211 1,185 2,792 779 3,571
Overall, a little over a fifth of the respondents were members of local SHG and/or mahila
mandals. The data seems to be indicating that such membership was primarily a rural
phenomenon.
3.4 Age at marriage and first cohabitation
In many parts of India, there exists the practice of the child bride staying at home for some time
(this could vary from a few days to a few years) before she moves into her husband‟s residence.
There can be many social-cultural reasons behind this but the more import aspect of this issue is
that the day she moves in with her husband, it is marked with festivities known as „gauna‟. Health
research has, for all practical purposes, always taken the date of „gauna‟ to be of more relevance
for cohabitation purposes than the actual date of marriage.
39
Taking 18 years to be the legal age of marriage for women, the proportion of women who had
actually cohabitated below that age in each of the three districts is as follows. Table 3.8 shows
the highest percentage of cohabitation of girls in MP stands between 15-18 years.
Table 3.8: Age at first cohabitation, NIPI-08

Indicator District Total
Hoshangbad Narsimhapur Raisen N %
Age At Cohabitation (in Years) N % N % N %
15-18 796 67.2 823 68.5 913 77 2532 70.9
19-21 293 24.7 293 24.4 216 18.2 802 22.5
22-25 79 6.7 70 5.8 44 3.7 193 5.4
26-30 15 1.3 14 1.2 9 0.8 38 1.1
31-40 1 0.1 2 0.1 3 0.3 6 0.1
Total 1184 100 1202 100 1185 100 3571 100
Across all three districts, for the majority of woman, the age at first cohabitation seems to have
been 15-18 years, followed by 19-21 years. More women in Raisen (77%) seem to have
cohabitated at a younger age than the other two districts.
The question now is, does age at first cohabitation get influenced by the education level of the
women concerned or the economic well being of her household? The following table elaborates.
Table 3.9: Relationship between age of first cohabitation and education and economic status of
respondent, NIPI-08
Indicator Rural Urban Total
N Mean Median N Mean Median N Mean Median
Education of No schooling 1,290 17.0 17.0 187 17.5 18.0 1,477 17.1 17.0
respondent <5 138 17.9 18.0 32 18.2 18.0 170 18.0 18.0
5-7 593 17.6 18.0 157 17.8 18.0 750 17.6 18.0
8-9 511 18.1 18.0 176 18.6 18.0 687 18.2 18.0
10-11 154 18.9 19.0 91 19.5 19.0 245 19.2 19.0
12 & above 106 20.7 20.0 136 21.9 21.0 242 21.4 21.0
Household Lowest 1,534 17.2 17.0 196 17.4 18.0 1,730 17.2 17.0
Wealth Second 398 17.5 18.0 107 18.1 18.0 505 17.6 18.0
Index Middle 309 17.9 18.0 129 18.5 18.0 438 18.0 18.0
Fourth 277 18.3 18.0 147 19.3 19.0 424 18.7 18.0
Highest 274 19.2 19.0 200 20.5 20.0 474 19.7 19.0
Total 2,792 17.6 18.0 779 18.8 18.0 3,571 17.9 18.0
It is clear from the above table that more educated women tend to delay getting married and
thereby cohabitate at a more advance and mature age than those who are illiterate. In our
sample, the median age of cohabitation of illiterate women was 17years while that of those
th
educated beyond the 10 standard was 19-21years. Similarly, women belonging to a higher
economic profile married/cohabited 2 years later than those who were illiterate (17 years).
40
Chapter 4
Maternal Health
“To have healthy society, you have to have healthy mothers”
4.1 Preamble
Maternal health:- As per millennium development goal 5 ( improving maternal health) and one of
the important component of NRHM is reducing maternal mortality through a number of
interventions. They are essential obstetric care which intends to provide the basic maternity
services to all pregnant women by ensuring early registration of pregnant women, at least three
ante-natal checkups for taking preventive and promotive steps and to detect complications early
for prompt action and at least three post-natal check ups to monitor the post-natal recovery. The
provision of emergency obstetric care is through establishment of First Referral Units; Institutional
delivery is by providing round-the-clock delivery services in PHCs/CHCs. The other interventions
include provision of safe abortion services, prevention and management of RTI/STI, holding of
RCH Camps in remote areas and training of Dais for clean and safe delivery.
“Most of the women dies during pregnancy and child birth, due to improper health care and lack
of knowledge of complications.”
4.2 Antenatal Care
Antenatal care or ANC is the care of a pregnant …I have to make regular home visits…tell
them about ANC…refer pregnant women to
woman during the time in the maternity cycle that
hospital under JSY…arrange for free
begins with conception and ends with the onset of treatment upto Rs. 20,000/- under Ladli
labor. This particular section of this chapter will deal Lakshmi Yojana, Deen Dayal Antodaya
with the issues of pregnancy registration, ANC Yojana, etc.,… help and assist ASHA and
provider, timing and number of ANC received, AWW… - Saroj Varma, ANM, Village
components of ANC received, and awareness of Singanama, Pipariya, Hoshangabad
pregnancy complications by mothers and health
problems and treatment seeking behaviour during last pregnancy.
This particular section of this chapter will deal with the issues of pregnancy registration, ANC
provider, timing and number of ANC received, components of ANC received, awareness of
pregnancy complications by mothers and health problems and treatment-seeking behaviour
during last pregnancy.
41
4.2.1 Pregnancy registration and ANC provider
Table 4.1: Percentage of pregnancies registered vs. key background variables, NIPI-08
Indicator Hoshangabad Narsimhapur Raisen All districts

Age Group % % % %
15-18 100 89.5 95.8 95.4
19-21 98.9 92.9 94.1 95.2
22-25 98.1 92.1 92.3 94.1
26-30 96.8 91.9 95.9 95.1
31-40 91.4 86.2 87.0 88.4
41-49 100 33.3 87.5 75.0
Years of schooling
None 94.7 90.1 89.4 91.3
<5 98.5 91.3 100 97.1
5-7 98.4 92.4 95.2 95.3
8-9 100 93.7 96.5 96.7
10-11 99.0 93.8 94.0 95.9
12 & above 100 93.9 95.5 97.1
HH Wealth Index
Lowest 95.0 90.0 91.9 91.9
Second 100 91.2 95.1 95.8
Middle 98.1 95.0 92.0 95.0
Fourth 98.8 95.0 94.9 96.5
Highest 99.1 97.2 95.9 97.7
Total 1154 1103 1202 3362
Figure 4.1: Registration of pregnancies by type of facilities
100
7.5 7.3 8.6
10.9
Percent
90
92.5 92.7 91.4
89.1
80
Hoshangabad Narshinghpur Raisen MP
Private facility Government facility
The table above shows that comprising of 3 districts in M.P, 91.4% of families gets their
pregnancies registered at government facilities, rest 8.6% get them registered at private facilities.
The district of Narsimhapur has 10.9% of families, which registered pregnancies at private
facilities, it is the highest among the 3 districts while Raisen has the lowest (7.3%) of private
facility registered pregnancy.
All the respondents were asked about registration of pregnancies at any source, it was found the,
highest number (97.5%) of pregnancies was registered Hoshangabad followed by Raisen (93.1)
and Narsimhapur (91.8). Registration of pregnancies are more common among young women
below 30 years than among older women, it is more common among those who had given their
first birth.
42
A general trend was that more literate women tended to get their pregnancy registered than those
who were illiterate. Women from relatively affluent families did register their pregnancies more
than those who were poorer.
Table 4.2: Received ANC Card, NIPI-08

Received Hoshangabad Narsimhapur Raisen All districts
ANC Card Yes Seen Yes but Yes Seen Yes but Yes Seen Yes but Yes Seen Yes not
not seen not seen not seen seen
% % % % % % % %
Total 73.2 20.2 57.0 33.6 64.5 24.1 65.1 25.8
91 % of the interviewed women had claimed that they had an ANC card while this could be
physically verified for only 65.1 % of them. Availability of the ANC card was lowest in Narshimpur
district and much higher in the Hoshangabad districts.
Table 4.3: Incidence of receiving ANC during last pregnancy, NIPI-08
Indicator Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
Yes, went to
94.3 96.9 95.1 87.1 91.5 87.9 81.8 87.2 82.8 82.8 92.8 88.6
health facility
Yes, health
personnel 2.2 0.3 1.6 2.5 2.8 2.6 10.6 4.7 9.5 9.5 2.2 4.6
visited home
No 3.5 2.8 3.3 10.4 5.7 9.5 7.6 8.1 7.7 7.7 5.0 6.8
Total 100 100 100 100 100 100 100 100 100 100 100 100
Overall, most women seem to have gone in for …make regular visits to the mother and child
some form of ANC service during their last and pregnant women…I do not have
pregnancy. The non-compliance is less than 3% anything with me…everything in the
Anganwadi center…from there I am able to
in case of urban areas and below 5% in case of give „healthy‟ food to women…I report to
rural areas. Only in rural areas of Narsimhapur ANM…she corrects me if I am wrong…ANM
district was there any significant non-compliance didi gives medicines etc. to me to be given
issue (10.4%). to mothers… - Puna Goud, ASHA, Devari,
Chawarpatha, Narshimhapur
Table 4.4: Place of ANC, NIPI-08

Place of ANC (multiple response) District
Total
% % % %
Government/ Municipal Hospital 22.8 22.3 14.8 20.1
CHC/ Rural Hospital 23.2 14.5 18.1 18.7
PHC 7.8 11.9 17.1 12.1
Sub Center/ANM 10.3 6.2 8.6 8.4
AWW/AWC 35.3 30.4 21.7 29.5
NGO/Trust Hospital/Clinic 0.2 0.1 0.8 0.3
Govt. Ayush Hospital/Clinic 0.1 0.0
Private Ayush Hospital/Clinic 1.2 0.7 0.4 0.8
Private Hospital/ Clinic 20.3 24.4 20.4 21.7
Total # of women 1,126 1,056 981 3,163
Table 4.3 shows the percentage of women who had received any ANC during her last pregnancy
by place. Women received ANC from various sources such as; AWC, government and private
hospital, PHC, trust hospital and AYUSH hospitals. Most commonplace for ANC in all districts
was AWC (29.5%) followed by private hospitals (21.7%) and government/municipal hospitals
(20.1%). Other than this about (18.7%) woman visited CHC and (12.1%) sub center.
43
Table 4.5: ANC provider, NIPI-08

Who provided ANC (multiple responses) District Total
% % % %
Government Doctor 26.9 14.7 22.1 21.3
ANM/Nurse/Midwife/LHV 58.2 69.0 60.7 62.5
ASHA 1.1 1.6 1.7 1.5
Private Doctor 17.7 19.0 16.9 17.9
Dai 0.5 0.5 1.1 0.7
Anganwadi/ICDS Worker 31.1 11.8 14.4 19.3
Total # of women 1,145 1,087 1,094 3,326
Table 4.5 shows providers of ANC. Women who went in for ANC services either by visiting the
service facility or having someone visiting their home, in the majority cases the care was provided
by the ANM/Nurse/Midwife (62.5%). Other than this women approached government doctors
(21.3%), private doctors (17.9%) and a similar share being contributed by the AWW/ICDS worker
(19.3%). The trend was very similar across all three districts.
Organizational issues affecting program “…We are monitored in certain meetings

implementation in which the ANM didi comes or our
It was observed during the data collection supervisor comes…our registers are
process, there is a conflict between three primary checked…we are given feedback on our
service providers at village level. As separate work…” – Suman Sasuley ASHA, village
entity and not from the same village ANM seems Kalari Path Bandi, Itarsi, Hoshangabad
to have good relations with both ASHA and AWW.
Before ASHA, ANM perform all her duties in coordination with AWW.
After implementation of NRHM and appointments of ASHA it was found replication of work
between ASHA and AWW, which leads conflict between the two locally available service
providers.
Case Study: District Hoshangabad

 In Hoshangabad district some of the areas were tribal dominated, hence staying in a sub
center village for ANM is not possible, hence this leads long commuting hours and delay
in primary health care. For all small and big medical emergencies particularly related to
maternal and newborn health community has to approach nearest PHC
 As the case in other districts here too there was high workload by way of paper work and
maintenance of records
 The only major „health‟ work the ANMs could contribute in was immunization
 There was criticality regarding ASHAs but conflict of interest was reportedly less than that
in Narshimhpur
 The reason may lie in the fact that since ANMs were not in a position to visit their villages
regularly, major portion of their work was being done by the ASHAs
There was witnessed greater support mechanism between ASHA and ANM in this district
Details of relationship between place of ANC/service providers and critical background variables
(age, education and economic status of respondents) have been provided in the Annexure
Tables.
4.2.2 Timing and number of ANC
Antenatal care has a very important bearing on the survival of mothers and their children. This
section discusses about the trends in the indicators of antenatal care in MP and India.
44
Figure 4.2: Percent of Mothers who received three or more antenatal checkups
51
44
60 40
50
27
40
30
20
10
0
NFHS 2 NFHS 3
India Madhya Pradesh
Trends in Antenatal care indicators show a slow progress in Madhya Pradesh compared to all
India, but shows improvement in the recent past. In MP only two fifth of the pregnant women had
at least three antenatal checkups during their last pregnancy as against more than half in India
(NFHS-3).
Table 4.6: Number of ANC received and timing of ANCs received, NIPI-08
Indicator Hoshangabad Narsimhapur Raisen All districts
% % % % % % % % % % % %
Number of ANC visits and timing
Received one ANC 12.4 4.6 10 16.7 8 15.1 17.3 11.3 16.3 15.6 7.3 13.7
Received two ANC 28 19.9 25.6 41.5 28 39 38.9 33.5 37.9 36.4 25.7 34
Received three ANC 58.9 74.6 63.7 41.1 64 45.4 43.2 54.1 45.2 47.4 66.4 51.6
Don't Know 0.7 0.9 0.7 0.7 0.5 0.6 1.1 0.6 0.6 0.6 0.7
Number of months pregnant at 1st ANC
<4 58.7 68.8 61.7 55.1 71 58 51.4 46.9 50.6 54.9 63.6 56.9
4-5 27.8 20.8 25.7 30.6 23 29.2 33 35.6 33.5 30.5 25.3 29.4
6-7 8.1 5.2 7.2 8.1 4.5 7.5 9.9 14.4 10.7 8.7 7.4 8.4
8+ 2.9 2.3 2.7 5.3 1.5 4.6 4.4 2.6 4.1 4.3 2.2 3.8
Don't Know 2.5 2.9 2.7 0.9 0.7 1.3 0.5 1.1 1.6 1.5 1.5
Total 799 346 1145 887 200 1087 900 194 1094 2586 740 3326
DLHS3 indicates that more than one third of “…4-5 years back we have to tell women about
the pregnant women had at least three pregnancy registration and ANC care, but know
antenatal checkups during their last young women themselves come and for
pregnancy .In Hoshangabad and registration and ask for better ANC care. More over
Narsimhapur districts more than two fifth of they follow the instruction, what ever we tell them
the pregnant women had at least 3 to do …..this may be due to various health
antenatal checkups during their last awareness programme on radio and TV .
pregnancy (48 percent and 43 percent) as Ragini Tiwari AWW , bankhedi block Hosangabad
district
against Raisen District, where the
corresponding figure was 27 percent.
Similarly, on being asked about number of
ANC received during reference period, it was found that majority of the received recommended 3
ANC. Consistently across all districts, the predilection to get more ANC checkups was more in
urban areas than in the rural areas.
45
th
Nearly all the women had received their first ANC within the 4 month of their pregnancy. More
the 50% had received it within their first trimester itself. The findings are consistent across all
three districts. Further to that it was found that the trend of ANC care is higher among the young
women below 30 years and who had their first pregnancy.
4.2.3 Components of Antenatal Care
This section looks at the types of ANC services received by pregnant women. It further
investigates whether the proportion of eligible women who had gone in for ANC had received
antenatal care as per the prescribed medical norms. This includes at least 2 TT injections and 90
day+ of IFA tablets consumptions.
Figure 4.2.3: Percent of Mothers who consumed IFA for 90 days and Received 2 or
more TT during Pregnancy
22
25 12
20
15
10
5
0
NFHS 3
Madhya Pradesh India
Consumption of IFA continuously for 90 days is considered vital for the survival of mothers and
children. In MP, one tenth of the mothers consumed IFA for 90 days during the last pregnancy,
against the national figure of 22%. Data on this indicator is not available for NFHS1 and NFHS2.
The reasons for less consumption of IFA need to be ascertained in the phase 2 of this study.
Table 4.7: Proportion of eligible women having received different components of ANC care, NIPI-08
Indicator Hoshangabad Narsimhapur Raisen State total

% % % %
At least 2 + TT injection 93.2 90.8 88.4 89.5
Took IFA for 90 days + 26.6 20.1 18.7 21.9
The incidence of women having received at least 2 TT injections is almost three times more of
those who consume IFA tablets for at least 90 days. This situation is consistent across all three
districts. The most important factor behind this is less supply of IFA tablets at village level and
poor perception among the women this may hinder child‟s growth.
46
Table 4.8: Nature of ANC service received, NIPI-08
ANC components Hoshangabad Narsimhapur Raisen State total

received Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
Weight measured 87.5 91.6 88.7 75.3 74.0 75.1 64.7 66.5 65.0 75.4 80.3 76.5
Blood Pressure
57.6 79.5 64.2 54.7 71.5 57.8 47.3 57.7 49.2 53.0 71.6 57.2
checked
Urine tested 51.7 77.2 59.4 56.4 76.5 60.1 41.2 57.2 44.1 49.7 71.8 54.6
Blood tested 67.3 82.1 71.8 57.2 75.0 60.4 53.4 62.4 55.0 59.0 75.0 62.6
Abdomen examined 61.2 85.0 68.4 68.8 82.5 71.3 59.4 59.3 59.4 63.2 77.6 66.4
Delivery date
42.2 70.5 50.7 35.7 53.0 38.9 39.0 49.0 40.8 38.9 60.1 43.6
declared
Delivery advice
34.9 50.3 39.6 34.7 53.5 38.2 32.4 40.7 33.9 34.0 48.6 37.3
given
Received advice on
care during 65.6 83.5 71.0 63.5 77.0 66.0 58.8 57.2 58.5 62.5 74.9 65.2
pregnancy period
Received advice on
danger signs of 23.4 28.0 24.8 10.9 19.5 12.5 20.0 24.2 20.7 17.9 24.7 19.5
pregnancy
Received advice on
27.5 39.3 31.1 23.8 28.5 24.7 26.8 28.4 27.1 26.0 33.5 27.7
delivery care
Breast feeding
25.3 28.0 26.1 18.3 23.0 19.1 16.6 26.3 18.3 19.8 26.2 21.3
advice
New Born Care
21.3 25.7 22.6 21.4 33.0 23.6 17.4 22.7 18.4 20.0 26.9 21.5
advice
Family planning
12.4 7.5 10.9 7.3 10.5 7.9 8.9 13.4 9.7 9.4 9.9 9.5
advice
Total 799 346 1145 887 200 1087 155 194 1094 2586 740 3326
(Multiple Response)
The above table provides details of the service and advice received by the pregnant women
during ANC care. It may be noted that the most common ANC components received were
measurement of weight and abdomen examination, followed by blood and urine test. Nearly a
similar number had received advice on care
“As per my Job description I am suppose to during pregnancy period. Consistently, more
distribute IFA tablets to pregnant women,
women in the urban areas had received
but I never receives adequate supply of IFA
different components of ANC than their rural
tablets “. ASHA from Raisen
counterparts. Across all three districts, the
features those were conspicuous by their
absence advice on newborn care, family planning advice, etc. A very percentage of women
received any advice on breast-feeding it is only (19.8 %) in rural and (26.2%) in urban area.
Furthermore, only (17.9%) in rural areas and (24.7%) in the urban areas had reported that they
had received any advice on danger signs during pregnancy.
Most important component of ANC is to create awareness about complication during pregnancy
and breast-feeding; which is lacking in districts, this is due to improper communication between
providers and consumers.
47
A typical ANM‟s load of “paper” work
With minor variations these were the minimum “paper work” an ANM was supposed to do. Nature
of ANM intervention therefore became primarily that of being facilitator to more „local‟ service
providers like the ASHA and the AWW.
 Maintain a host of „registers‟ and report cards
 Respondent ANMs were aware that they were the first tier of official information and data
gathering regime
 Respondents narrated the whole gamut of paper work maintained by them, which
included:
 Birth register
 Death register
 ANC report card
 Blood slides report card
 Stock distribution register
 CSM report card
 New born register
 PNC report card
 JSY register
 Survey register
 IUD register
 Cash Book
 VHSC register
 NRHM register
 Vaccine register
 Mamta register
 Condom register
 Motivation register
 Minor treatment register
 Today diary
 Respondents had to maintain in addition Report schedules running into 156 column data
sheets, which they had to update regularly to be submitted with district officials
The ANM was involved in a number of roles; she was in fact the nodal person for more
comprehensive area coverage and guide to „locally‟ available service providers, based in
individual villages, viz., the ASHAs and the AWWs.
This multiplicity of roles and overextension of service area impinged on quality of service
provided.
Table 4.9: TT injections vs. number of ANCs Nature of ANC service received, NIPI-08
Locality Indicator One TT Two TT Two and More ANC

% % %
Rural Received one ANC 48.8 12.5* 8.6
Received two ANC 27.6 40.6 17.4
Received three + ANC 23.6 46.9 74.0
Urban Received one ANC 37.8 4.0* 5.8
Total Received one ANC 46.8 10.6* 7.8
* We have to care check the data
48
The above table makes it quite obvious that “…I see to it what kind of work the AWW and
there is a positive relationship between the ASHA is doing…like monitor
number of TT injections received and the immunization…if there has been proper
number of ANC services availed. Across both registration of pregnancy or not…if the ANC
urban and rural areas, one can see that the is reaching pregnant women…” – Shahin Ali,
incidence of having received 2 or more TT ANM, village Bareli, Raisen
injections increases steadily as one progress
from one ANC to 2 or 3 and more ANCs.
4.2.4 Health problems and treatment seeking behaviour during pregnancy
This section looks at the general level of awareness among the women respondents regarding
the types of complications/health problems that can occur during pregnancy. It also looks at the
incidence of occurrence of health problems during last pregnancy as well as explores the details
of treatment seeking behavior.
Table 4.10: Knowledge about health problems during pregnancy, NIPI-08
Pregnancy Complication Hoshangabad Narsimhapur Raisen State total

% % % % % % % % % % % %
Vaginal Bleeding 8.5 6.1 7.8 3.5 11.0 4.9 5.6 13.9 7.0 5.8 9.5 6.6
Convulsions 13.1 5.5 10.8 3.5 6.5 4.0 6.4 11.3 7.3 7.5 7.3 7.5
Prolonged Labour 7.8 5.8 7.2 10.0 8.0 9.7 5.6 14.4 7.1 7.8 8.6 8.0
Swelling of Hands and Feet 26.4 15.3 23.1 12.5 19.0 13.7 16.4 32.5 19.3 18.2 20.8 18.8
Any other 6.6 11.6 8.1 5.4 6.5 5.6 7.4 17.0 9.1 6.5 11.6 7.6
Personnel who told about these complication
Health Personnel /Doctor 8.9 6.1 8.0 3.9 13.0 5.6 6.0 15.5 7.7 6.2 10.4 7.1
ANM/Nurse/Midwife/LHV 6.1 3.5 5.3 5.5 3.0 5.1 4.6 7.7 5.1 5.4 4.5 5.2
ASHA 0.3 0.2 0.1 0.1 0.7 0.5 0.3 0.3
Other Health Personnel 0.1 0.1 0.2 0.2 0.1 0.1
Other Person Dai/TBA 0.2 0.5 0.3 0.1 0.1 0.1
Aganwadi/ICDS Worker 3.4 0.9 2.6 2.4 2.5 2.4 1.3 1.0 1.3 2.3 1.4 2.1
Home 16.4 13.3 15.5 12.9 15.0 13.2 8.6 17.5 10.1 12.5 14.9 13.0
Any Other 3.0 2.0 2.7 2.5 4.0 2.8 3.3 5.2 3.7 2.9 3.4 3.0
Don't Know 64.2 69.9 65.9 79.1 71.0 77.6 76.6 56.7 73.0 73.6 66.8 72.1
Total 799 346 1145 887 200 1087 900 194 1094 2586 740 3326
…We always try to convince expectant Most of the women seemed to have been aware of
mother to take IFA tablets, but due to swelling of hands and feet as a tangible pregnancy
prevailing thoughts and myths about complication, perhaps because they would have
IFA, stopped mothers for consuming experienced first time Apart from this, no more than a
them. AWW from Hosangabad fifth of the respondents were actually aware of any
other symptom. 72% of the women claimed not to
have had any knowledge about any of the
complications during pregnancy.
Most of the eligible women seemed to have come to know about complications from home (13%)
and from health personnel at service locations where they had gone in for ANC (7.1%).
49
ANM problems related to location transport and reach affecting impact and program
design issues
As mentioned by one of the ANM from
…I need two assistants…it is difficult to „cover‟ eleven Raisen district, the villages are more
villages on my own…we do not have sub-center scattered, hence we faced lots of
here…have to travel a lot… - Kanta Kushwaha, ANM,
problems in terms of coverage, in our
village Semrakhas, Silvani, Raisen
district almost 15% ANM post are
vacant and we were given additional
villages to cover. On day of immunization we have to carry 7-8 kg load which (contains vaccine
boxes, records and other medicine) on our soldiers.
Table 4.11 Incidence of health problems during pregnancy, NIPI-08

% % % % % % % % % % % %
Yes 43.8 48.0 45.1 19.7 18.5 19.5 42.9 48.5 43.9 34.1 39.3 35.3
No 56.2 52.0 54.9 80.3 81.5 80.5 57.1 51.5 56.1 65.9 60.7 64.7
Total # of women 799 346 1145 887 200 1087 900 194 1094 2586 740 3326
35% of the women in our sample had experienced some sort of health problems during their last
pregnancy. In the districts of Hoshangabad and Raisen, more urban women faced problems than
their rural counterparts but the situation were reverse in Narsimhapur district. The incidence of
health problems during pregnancy was more pronounced in Hoshangabad district (45.1%) than
the others.
Table 4.12: Nature of health problems faced during last pregnancy, NIPI-08
Problem during District
State total
pregnancy Hoshangabad Narsimhapur Raisen
(Multiple responses) Rura Urban Total Rural Urban Total Rural Urban Total Rural Urban Tota
l l
% % % % % % % % % % % %
Swelling of hands &
feet 47.6 59.8 51.5 40.5 69.2 45.4 41.8 48.0 43.0 43.8 57.2 47.0
Paleness 21.4 28.4 23.7 27.4 12.8 24.9 24.3 13.3 22.1 23.8 21.6 23.3
Visual disturbances 20.9 18.3 20.1 25.8 15.4 24.0 16.8 17.3 16.9 20.1 17.6 19.5
Excessive bleeding 8.1 5.9 7.4 11.1 7.7 10.5 9.7 20.4 11.8 9.3 10.8 9.7
Convulsions 37.0 23.7 32.8 15.8 17.9 16.2 22.3 16.3 21.1 26.5 20.6 25.1
Abnormal position of
foetus 3.9 4.1 4.0 5.3 10.3 6.1 6.4 5.1 6.2 5.2 5.2 5.2
Weak or no movement
of foetus 18.1 18.3 18.2 24.2 25.6 24.5 10.1 4.1 9.0 15.9 14.7 15.6
Others 37.3 36.1 36.9 34.7 30.8 34.1 51.7 56.1 52.6 42.9 41.8 42.7
Total N 359 169 528 190 39 229 404 98 502 953 306 1259
Complications during pregnancy may adversely affect both mother‟s health and outcome of the
pregnancy. Early detection of complication during pregnancy and their management are
important component of the programme. As given in the table 4.12, about 47.0% of the women
faced problem of swelling on hands and feet. While 25.1% of the women had convulsions, 23.3%
had paleness and 15.6 % of the women reported no movement of fetus, other problems
excessive bleeding and abnormal position of fetus was reported by 9.7 % and 5.2% of the
women.
Most of the health problems during pregnancy indicate that women had anemia; this is in
correlation with low intake of iron supplement (IFA) and poor nutritional diet. Most of the women
who had health problem were from low and medium wealth index, between the ages of 30-40
years.
50
Table 4.13: Percentage of women who sought advice for heath problem during pregnancy, NIPI-08

% % % % % % % % % % % %
Yes 74.9 87.0 78.8 48.9 76.9 53.7 77.2 77.6 77.3 70.7 82.7 73.6
No 25.1 13.0 21.2 51.1 23.1 46.3 22.8 22.4 22.7 29.3 17.3 26.4
Total # of women 359 169 528 190 39 229 404 98 502 953 306 1259
Of all the total 1259 (953 rural and 306 urban) women who had reported to face any
complications during pregnancy, over 73% had consulted someone regarding their problem. The
…I make regular visits to mothers and usual places of consultation had been Private
pregnant women…I case of complications I hospitals/doctors (49.7%), followed by CHC/rural
take them to the sub-center… - Shiksha Malik, hospital (21.9%) in rural areas, and government
ANM, Village Kutanasir, Bareli, Raisen hospital (16.7%), in case of urban areas.
Overwhelmingly (73.2%), it was the doctor who was the health personnel consulted when the
pregnant women went to a facility for a checkup for complications. However 27.1 % of the women
consulted ANM and Midwife.
Table 4.14: Person persuaded for treatment during pregnancy, NIPI-08

% % % % % % % % % % % %
ANM 4.8 4.8 3.3 3.3 5.5 10.7 6.5 5.5 3.6 5.0
ASHA 3.3 2.2 2.2 1.6 0.6 0.5 1.9 1.4
DAI 1.1 0.7 1.0 1.1 0.8 1.0 1.3 1.0 1.0 0.8 1.0
Mother-in-law 18.2 16.3 17.5 31.2 23.3 29.3 18.4 17.3 18.2 20.1 17.5 19.4
Husband 42.4 73.5 53.4 50.5 50.0 50.4 60.3 48.0 57.9 51.8 63.1 54.9
Friends/ 19.3 23.8 20.9 22.6 33.3 25.2 19.4 22.7 20.0 19.8 24.6 21.1
Relatives
Others 14.5 6.8 11.8 4.3 6.7 4.9 10.6 12.0 10.9 11.3 8.3 10.5
Total number 269 147 416 93 30 123 13 75 385 672 252 924
of women
Overwhelmingly, it was the husband (54.9%) who had persuaded the woman to go in for
treatment of complication experienced during the pregnancy period. This is fairly consistent
across all three districts and it is also consistent that the role of the husband was more
pronounced in urban households than the rural households. The role of the ANM seems to have
been relatively limited except for the district of Raisen where they did seem to have played a role
with around 10% of the pregnant women.
4.3 Delivery Care
One of the important thrusts of the program is to encourage deliveries under proper hygienic
conditions (delivering under clean conditions, washing hands with disinfectant before delivery,
etc.) and under the supervision of qualified/ experience health professional. For each live/stills
birth during two years preceding the survey, we had asked the women place of delivery, which
assisted during the deliveries in case of home deliveries, characteristics of delivery and any
problems that occurred during the delivery process. This section provides the details.
51
Figure 4.3.1: Percentage of Institutional deliveries - MP and India
41
50 34
30
40 22
30
20
10
0
MP India
NFHS-3 NFHS-2
As per NFHS-3, more than one fourth of the deliveries in MP were institutional deliveries
indicating a slight improvement since NFHS 2 (from 22% to 30%). At the national level, two fifth of
the deliveries were institutional.
Figure 4.3.2: Percentage of births assisted by health personnel
India 48
MP 28
0 20 40 60
NFHS-3
NFHS-3 indicates that more than one fourth of the births were assisted by
doctors/nurse/LHV/ANM other health personnel in the state as against the national average of
48%.
52
Figure 4.3.3: Percentage of Births assisted by skilled personnel in NIPI districts
Narsimhapur 41%
Raisen 31%
Hoshangabad 39%
MP 36%
0 20 40 60
Birth assisted by skilled personel
Around one fifth of the women in the NIPI districts Hoshangabad (20 %), Raisen (18 %) and
Narsimhapur (19 %) delivered at government institution.
Though NFHS 3 indicates 28% of the deliveries being assisted by health personnel, DLHS
indicates a figure of 36%. This proportion varied from 32% in Raisen and 41% in Narsimhapur
with Hoshangabad recording 39 %.
Given the cash incentives offered to women for hospital delivery, it is interesting to note that most
women still prefer to have their children at home, or in the village of their mother. Discussions
with District Immunisation Officers (DIO) reveal that the following factors lead to low levels of
institutional deliveries in the NIPI districts:
Many villages are remote and some are inaccessible by vehicle, making journey to the hospital
difficult one.
If transport is available, it is expensive and women lack the funds to pay for the vehicle up-front.
Traditional dictates that the first-born child is to be born in the village of the mother's family.
Place of Delivery
69.6 66.8 64.6
70 57.4
60
50
Percent
40 28.9
26.7 23.7
30
15 15.5 13.7
20 11.7
6.5
10
As per0 the NIPI-08 baseline Hoshangabad district showing the highest percentage (85%) of
institutional deliveries
Hosangabad (governmentNarshinghpur
+ private) followed by Raisen (73%) and Narsimhapur
Raisen MP (71%).
Data reveals that Government facility more number
in Hoshangabad, Privateof
facility
women (70%) Home andfor
is going others
institutional
deliveries in government hospitals in comparison to other two districts In the same district
percentage of institutional deliveries in private hospitals (15%) is highest among three NIPI
districts.
N: N:120 N:118 N:357
4.3.1 Influence of background characteristics on choice of place of delivery
53
The following section explores the relationship between the place of last delivery and critical
background variables, viz. age of respondent, her education level, child‟s birth order and standard
of living level of her household based on Asset Ownership Index.
Table 4.15: Place of delivery v/s age of respondent, NIPI-08
Indicator Institutional Home Total

Govt Hospital Private In-laws Parental Other places All Births
Age N % N % N % N % N % N %
15-18 56 64.4 3 3.4 25 28.7 3 3.4 0.1 87 100
19-21 598 70.4 93 10.9 134 15.8 23 2.7 1 0.2 850 100
22-25 1,005 63.9 195 12.3 319 20.3 43 2.7 4 0.8 1,572 100
26-30 493 62.2 94 11.6 168 21.2 32 4.1 5 0.9 792 100
31-40 146 56.6 34 13.2 62 24 10 3.9 5 2.3 258 100
41-49 8 66.7 1 8.3 3 25 0.1 12 100
Total N 2,306 64.6 419 11.7 711 19.9 111 3.1 15 0.7 3,571 100
Nearly 76.3% of all deliveries took place in

…It is my task to arrange for any vehicle
institutions, in which, (64.6%) in government while taking pregnant for delivery…I stay in
hospitals, while only 22.4% took place at home. the hospital during delivery…I have to stay
The trend in the data clearly indicates that the with the mother for 3-4 days before
younger generation preferred to have their delivery…in hospital I have to see that bed is
deliveries in an institution while the older women arranged and the mother finds proper care…
preferred to have their deliveries at home. One of - Nilu Mukesh Dubey, ASHA, village
the explanations for such a trend was that while Devakchahar, Narsinghpur
for many of the elder women this pregnancy was
one of the several she has already had and hence they felt that it could be handled from home,
for the younger lot, this was the first pregnancy and they did not want to risk it.
Table 4.16: Place of delivery v/s years of schooling, NIPI-08
Age of Institutional Home Total

women Govt Hospital Private In-laws Parental Other All Births
places
N % N % N % N % N % N %
None 943 63.8 60 4.1 395 26.7 62 4.2 12 1.2 1,477 100
<5 115 67.6 20 11.8 30 17.6 5 2.9 0.0 0.1 170 100
6-7 521 69.5 56 7.5 144 19.2 25 3.3 3 0.5 750 100
8-9 454 66.1 109 15.9 110 16 14 2 0.0 0 687 100
10-11 152 62 72 29.4 18 7.3 3 1.2 0.0 0.1 245 100
12+ 121 50 105 43.4 14 5.8 2 0.8 0.0 0 242 100
Total N 2,306 64.6 419 11.7 711 19.9 111 3.1 15 0.4 3,571 100
54
The preference for institutional deliveries is strong

among all women irrespective of her literacy level. …JSY has made a difference …now most
However, with literacy, the propensity to deliver at want institutional delivery…in some
deliveries the TBA goes…in some the
home comes down quite drastically (from 26.7% AWW…sometimes they do not think it
for illiterate women to 7.3% or lower for those who necessary to tell me of the delivery…may be
th
have passed their 10 standard. money issue…people get their money …but
it takes time… - Pooja Govind Kanwar, ASHA,
Again, the preference for private institutional village Bodri, Gaukhara, Narsinghpur
delivery also increases with education of the
pregnant mother.
Table 4.17: Place of delivery v/s number of live children, NIPI-08
Birth Institutional Home Total

order Govt Private In-Laws Parental Other places All Births
Hospital
N % N % N % N % N % N %
1-2 1,536 65.6 363 15.5 376 16.1 54 2.3 6 0.5 2,340 100
3-4 630 62.1 52 5.12 275 27.1 47 4.6 7 1.08 1,015 100
5+ 140 64.8 4 1.85 60 27.8 10 4.6 2 0.95 216 100
The hypothesis that younger women having their first child would rather have a risk free
institutional delivery rather than have it at home while more experienced women with children can
afford to think otherwise is more or less validated in the above table. Institutional deliveries come
down from 82% for women with 1-2 live children to 18.7% for those who had more than 2.
Table 4.18: Place of delivery v/s economic status of respondents‟ household, NIPI-08
Wealth Institutional Home Total

Index
Govt Hospital Private In-laws Parental Other places All Births
N % N % N % N % N % N %
Lowest 1,162 67.2 46 2.7 434 25.1 73 4.2 8 0.8 1,730 100
Second 347 68.7 43 8.5 99 19.6 13 2.6 3 0.6 505 100
Middle 292 66.7 54 12.3 77 17.6 12 2.7 2 0.7 438 100
Fourth 281 66.3 80 18.9 53 12.5 8 1.9 2 0.4 424 100
Highest 224 47.3 196 41.4 48 10.1 5 1.1 0.0 0.1 474 100
Total 2,306 64.6 419 11.7 711 19.9 111 3.1 15 0.7 3,571 100
The generic trend was that women with lower economic profile tended to favour having deliveries
at government facilities as against those who belonged to better off households and could afford
private treatment.
55
4.3.2 Arrangement and cost of transport
Family members, usually the husband, had the responsibility of arranging the transport for taking
the pregnant woman to the health institution.
Table 4.19: Average transportation expenses, NIPI-08
District
Total
N 623 97 720 492 279 771 585 253 838 1,700 629 2,329
MEAN 472.5 347.6 455.7 719.3 389.8 600.1 572.0 210.6 462.9 578.2 311.2 506.1
Median 400.0 300.0 350.0 600.0 300.0 500.0 500.0 130.0 400.0 500.0 200.0 400.0
There are wide variations in the transportation incurred both across urban and rural areas as well
as across districts. The urban-rural differences are most stark across Narsimhapur and Raisen
districts which range from as high as Rs.600 in Narsimhapur rural to as low as Rs.130 in Raisen
urban. The differences are far more modest in Hoshangabad district. The cost of transportation
was in general highest in Narsimhapur (Rs.500) and lowest in Hoshangabad (Rs.350).
4.3.3 Institutional delivery
This section elaborates on issues dealing with nature of delivery and attending service provider,
incurred costs, health problems/complications experienced during delivery, nature of advice
received post delivery and from whom, and finally, opinion on quality of service and facility
standards.
Table 4.20: Nature of Institutional delivery, NIPI-08

Rural Urban Total Rural Urban Total Rural Urban Total
Who conducted the delivery % % % % % % % % %
Government Doctor 12.5 27.3 17.2 12.5 25.5 15.6 39.7 37.6 39.2
Private Doctor 11.7 19.7 14.3 14 17.5 14.9 9.4 11.6 9.9
ANM / Nurse 73.8 52.7 67 73.4 57 69.5 49.6 48.1 49.3
Other 2 0.3 1.5 0.1 0 0 1.3 2.7 1.6
Type of Delivery
Normal 89.1 82.1 86.9 90.5 83.5 88.9 91.3 88.4 90.7
Cesarean 9.8 17.9 12.4 9.2 16.5 10.9 7.8 11.6 8.6
Assisted 1.1 0.0 0.7 0.3 0.0 0.2 0.9 0.0 0.7
Total N 682 319 1001 655 200 855 170 181 869
In line with where the delivery actually took place, the person actually performing the delivery was
primarily a government doctor in rural areas and government and private doctors in urban areas.
While most deliveries were normal, incidence of caesarian deliveries was more in urban areas.
Around 90.7% of the deliveries across both urban and rural areas were Normal deliveries.
Table 4.21: Cost incurred in institutional delivery, NIPI-08
Rupees Hoshangabad Narsimhapur Raisen State total

N 648 296 944 646 196 842 660 164 824 1,954 656 2,610
Mean 3,796 4,911 4,146 2,718 3,562 2,914 2,836 2,679 2,805 3,116 3,950 3,325
Median 1,500 1,350 1,500 1,400 1,500 1,500 1,500 1,500 1,500 1,500 1,500 1,500
56
The majority of deliveries were in government facilities.

The average (or mean) cost incurred on institutional …JSY is very popular…the „patient‟ is taken
to government hospital for delivery…she
deliveries came to around Rs.3325, while the median
gets between Rs. 650 and Rs. 250…I get Rs.
value was Rs.1500. The differences between urban and 350…poor people now go to government
rural hospital…rich people do not avail of
…all the villages in the block are covered by areas this…they go to „private‟… - Hemlata Ahirwar,
JSY…ASHA accompanies women for were Village Devri, Gadawara, Narsinghpur
delivery…almost all deliveries are in quite
government hospital now…very few in
pronounced across all the districts even though
home…about one in ten is now in
home…seven in government hospital and the median value was exactly the same. There
only two in „private‟… - Vinod Kr. Prajapati, is not much difference observed in rural and
B.M.O. Block Chawarpatha, Narsinghpur urban cost across the districts.
Table 4.22: Problem experienced during delivery by women of different age groups, NIPI-08
Premature Excessive Prolonged Obstructed Breech Other
Total
Labour Bleeding Labour Labour Presentation
Yes Yes Yes Yes Yes Yes Yes
Age N % N % N % N % N % N % N %
15-18 15 25.4 3 5.1 170 77.6 24 0.9 4 6.8 4 0.1 59 100
19-21 194 28.1 106 15.3 804 59.9 222 8.1 19 2.7 33 1.2 691 100
22-25 321 26.8 144 12.0 0.0 0.0 348 12.8 31 2.6 45 1.7 1,200 100
26-30 131 22.4 87 14.8 974 69.0 178 6.5 14 2.4 19 0.7 586 100
31-40 57 31.7 27 15.0 10 6.5 46 1.7 8 4.4 9 0.3 180 100
41-49 1 11.1 1 11.1 1 11.1 0.0 0.0 0 0.0 0.0 0.0 9 100
Total 719 26.4 368 13.5 132 5.9 818 30.0 76 2.8 110 4.0 2,725 100
Obstructed (30.0%) and Premature (26.4%) labour were major problems experienced by almost a
third of the women respondents had faced problems. This is consistent across the age groups.
Prolonged labour and premature labour were problems faced by a quarter of the respondents
across most age groups.
Table 4.23: Nature of advice received after delivery by source, NIPI-08

Advice Hoshangabad Total
Doctor Nurse ANM Others %
% % % %
New born care practices 45.5 50.9 1.9 1.7 100
Breast Feeding 43.3 54.1 1.1 1.5 100
Immunization 41.1 57.5 0.3 1.1 100
Routine check up 52.9 45.5 0.4 1.2 100
Spacing method 43.3 54.2 0.8 1.7 100
Advice Narsimhapur Total

Doctor Nurse ANM Others
% % % % %
New born care practices 34.5 62.3 3.2 0 100
Breast Feeding 37.1 59.9 3 0 100
Immunization 42.5 54.7 2.8 0 100
Routine check up 47.3 50.9 1.8 0 100
Spacing method 50 44.8 5.2 0 100
Any other advice 0 0 0 0 100
57
Advice Raisen Total

Doctor Nurse ANM Others
% % % % %
New born care practices 39.8 54.4 1.9 3.9 100
Breast Feeding 41.9 54.3 0.9 2.9 100
Immunization 42.9 55.0 0.4 1.7 100
Routine check up 50.3 49.0 0 0.7 100
Spacing method 54.4 43.9 0 1.7 100
Any other advice 33.3 66.7 0 0 100
80-85% of the respondents had confirmed that

they had received advice post delivery of their … After implementation of JSY, number of
child and the nature of advice included newborn institutional deliveries have increased, we
care practices, breast feeding, immunization, gave all possible advices to the mothers
routine checkup and spacing methods to be …… I can also see the impact of our advices
as compared to last year, this year more
adopted to delay the next child. It was mostly
number of children got basic immunization.
the resident doctor who imparted the advice. BMO, Itarsi block, Hoshangabad district
The only exception was that nurses in Raisen
districts seem to have been fairly active in giving
advice as well, but largely confined to issues of immunization and breastfeeding.
Table 4.24: Mothers perception about environment of health facility and behaviour of staff, NIPI-08
Services and staff in the District

Total
health facility Hoshangabad Narsimhapur Raisen
% % % %
Very Poor 2.8 1.2 6.3 3.4
Poor 5.9 8.2 9.2 7.7
Average 36.3 42.8 32.6 37.1
Good 45.1 43.2 45.7 44.7
Very Good 9.7 4.6 5.6 6.8
DK/CS 0.2 0 0.6 0.3
Environment of the health facility
Very Poor 11.3 4.3 14.4 10.1
Poor 11.1 12.2 15.0 12.7
Average 36.5 46.9 27.6 36.9
Good 32.2 31.8 36.9 33.6
Very Good 8.1 4.2 4.1 5.6
DK/CS 0.8 0.6 2.0 1.1
Behavior of the staff in health facility
Very Poor 2.5 0.6 4.7 2.6
Poor 6.9 6.1 10.1 7.7
Average 39.8 59.3 35.8 44.6
Good 40.9 29.1 42.0 37.5
Very Good 8.1 4.2 6.5 6.3
DK/CS 1.8 0.7 0.9 1.3
Total N 1001 855 869 2752
Mothers who had had their delivery in a health facility were asked to provide their opinion on the
quality of healthcare that they received. Whether it be the issue of service and staff of the facility
concerned, or the overall environment of the facility in terms of cleanliness ambiance, or the issue
of behaviour of staff, the general opinion was that „good‟ (as reported by 66-75% of respondents).
Overall similar natures of responses were observed across the district.
4.3.4 Janani Suraksha Yojana (JSY)
The following section looks at general awareness levels regarding the scheme and whether it is
influenced by the background characteristics of the eligible woman.
58
Table 4.25: Awareness about JSY, NIPI-08

Back ground State total Total
characteristics of the
Yes No All Births
women
N % N % N
Age
15-18 66 75.9 21 24.1 87 100
19-21 653 76.8 197 23.2 850 100
22-25 1151 73.2 421 26.8 1572 100
26-30 584 73.7 208 26.3 792 100
31-40 188 72.9 70 27.1 258 100
41-49 8 66.7 4 33.3 12 100
Years of schooling
No schooling 1063 72.0 414 28.0 1477 100
<5 127 74.7 43 25.3 170 100
5-7 583 77.7 167 22.3 750 100
8-9 530 77.1 157 22.9 687 100
10-11 179 73.1 66 26.9 245 100
12 & Above 168 69.4 74 30.6 242 100
Nature of PSU
Rural 2061 73.8 731 26.2 2792 100
Urban 589 75.6 190 24.4 779 100
Wealth Index
Lowest 1287 74.4 443 25.6 1730 100
Second 389 77.0 116 23.0 505 100
Middle 336 76.7 102 23.3 438 100
Fourth 323 76.2 101 23.8 424 100
Highest 315 66.5 159 33.5 474 100
Total N 2650 74.2 921 25.8 3571 100
Overall, 74.2% of the women respondents were aware of the JSY program. The data reveals that
more number of younger women were aware of the program than those who were in their 40s.
The propagation of the program does not seem to have been influenced by education level of the
respondent and illiterates and literates alike were both aware of JSY in large numbers.
Awareness level in urban areas (75.6%) was little higher than rural areas (73.8%). The
differences in awareness among women belonging to the lowest and highest wealth ownership
class were quite marginal. This speaks well for the overall effort of popularizing JSY, as it seems
to have penetrated all walks of life.
Salient finding on ASHA and her work

Trainings
 Almost all the ASHAs were aware of four modules of their training, although more than 50 % have
completed first modules only.
All the respondents received Rs 500/- after completion of training
General working condition of ASHA in the Village

 Good cooperation from PRI and other community leaders, but poor cooperation from Trained Dais
and AWW.
 Regular monitoring of work by ANM. All the respondents reported that they get time-to-time
instructions from ANM.
 All the ASHAs were aware of danger signs of pregnancy and delivery.
The respondents usually equipped with a medicine box containing medicines such as:
1. paracetamol
2. ORS
3. Chloroquinine
4. Betadine
5. Surgical gauze
6. Cotton
7. OPC
59
8. Vitamin A tablets and syrup

9. DOTS medicine
10. ASHA kit
11. DDK.
The content and nature of the medicine box varied over area. The place near to block or district
town had better equipped ASHA medicine box, since they were replenished regularly as per the
accounts given by the respondents themselves.
…in the village there is mothers‟ group meeting in the first

week of every month…this is attended by the ANM, AWW
and the woman PRI member…there is also a VHSC
here…the panchayat members are the representatives
there…I also go…I do not know about their budget or
expenses…I know only of the work that is to be
done…there is no „mahila mandal here… - Anju Bharat
Kuhar, ASHA, village Chichali, Narsinghapur
Table 4.26: Accompaniment of ASHA during Institutional delivery, NIPI-08

State total
Rural Urban Total
N % N % N %
Did the ASHA accompany you?
Yes 683 33.7 140 20.0 823 30.2
No 1174 58.0 496 70.9 1670 61.3
NA 168 8.3 64 9.1 232 8.5
Total 2025 100 700 100 2725 100
If no, did she reach later on?
Yes 164 14.0 115 23.2 279 16.7
No 1010 86.0 381 76.8 1391 83.3
Total N 1174 100 496 100 1670 100
Why did ASHA not accompany you?
1) We did not
660 65.3 199 52.2 859 61.8
inform her
2) We informed
but she refused 72 7.1 21 5.5 93 6.7
to come along
3) She was not
present in the 38 3.8 11 2.9 49 3.5
village
4) Don't Know 207 20.5 134 35.2 341 24.5
5) Any Other 33 3.3 16 4.2 49 3.5
Total N 1010 100 381 100 1391 100
As shown in the table 4.2.9, about 33.7 % in rural and 20.0 % in urban location ASHA had
accompanied the pregnant women to the hospital. In 16.7% of the case, she had arrived later on.
This essentially implies that only 50.4% of the cases, the pregnant women were attended by the
ASHA in the institution.
“…I earn about Rs. 1000/- per month as
However, it may also be noted that the absence ASHA…monthly honorarium is Rs. 500/-
…and for FP campaign I get Rs. 150/-…I get
of the ASHA was not really her conscious choice for immunization…then there is the Rs. 350/-
as in most cases (61.8%), she was not informed I get for each „institutional‟ delivery”… -
that the patient was being taken to the facility. In Lalita Pradip Singh, ASHA, village Patlai Kala,
less than 25% of the cases was she not present block Kesla, Hoshangabad.
in the village at that time or she refused to
accompany the pregnant woman.
“…I make regular visits to pregnant women and encourage them for institutional deliveries but
very few inform us, if they are going for institutional delivery…….
Swati Solanki ASHA Gotegaon block Narshingpur district
60
Table 4.27: Duration of stay of the mother at health facility after delivery, NIPI-08
Stay of Hoshangabad Narsimhapur Raisen State total

Mothers Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
<=6 Hrs 6.9 5 6.3 4.9 6.5 5.3 6 6.1 6 5.9 5.7 5.9
7-12 Hrs 2.1 0.6 1.6 0.5 0.5 0.5 3.1 1.7 2.8 1.9 0.9 1.6
13-23 H 0.3 0.3 0.3 0.2 0.1 0.3 0.2 0.2 0.1 0.2
1-2 days 41.5 33.5 39 33.6 34 33.7 43.9 47.5 44.6 39.8 37.3 39.1
3-6 days 41.9 48.3 44 53.7 45 51.7 40.4 38.1 39.9 45.2 44.7 45.1
Week of
More 7.3 12.3 8.8 7.1 14 8.7 6.3 6.6 6.5 7 11.3 8.1
About 45 .1 % of the women stayed 3-6 days in hospital post delivery. The trend was similar
across the districts. While 39.1% of the women stayed for 1-2 days, less than 6 % of women
stayed for less than 6 hours.
4.3.5 Home deliveries
This section deals with the details of home delivery cases, including reasons behind choosing to
have the baby delivered at home and not in an institution, the actually place where the delivery
took place and whether it is influenced by the background of the pregnant mother to be, the
person who actually conducted the delivery and finally, why was this person chosen to begin with.
Table 4.28: Reason for home delivery, NIPI-08
Reasons District State total

% % % % % % % % % % % %
Costs too 0.0
2.8 11.1 4.5 9.7 28.0 9.4 10.0 9.5 8.3 9.0 8.4
much
Facility not 0.0 0.0
9.1 2.8 7.8 4.5 21.0 1.4 1.3 4.2 1.3 3.9
open
Too far 44.1 19.4 39.1 44.8 16.7 108.0 41.3 3.3 37.7 43.3 12.8 40.5
No trust on
3.5 5.6 3.9 0.9 8.3 1.2 4.9 6.7 5.1 2.9 6.4 3.2
facility
No one to
12.6 22.2 14.5 9.4 16.7 9.6 15.4 13.9 12.3 12.8 12.3
company
Did not get
51.0 50.0 50.8 67.9 41.7 67.0 44.8 50.0 45.3 56.0 48.7 55.3
time
No female 0.0 0.0 0.0 0.0
provider at 0.7 0.6 2.1 2.0 1.0 0.9 1.4 1.3
facility
Husband/
family not
2.1 5.6 2.8 2.4 8.3 2.6 4.5 20.0 6.0 3.2 11.5 3.9
gave
permission
Not 0.0
9.1 2.8 7.8 8.5 8.2 11.5 23.3 12.7 9.7 10.3 9.8
necessary
No customary 2.1 0.0 1.7 1.5 8.3 1.8 2.8 20.0 4.4 2.1 9.0 2.7
Any Other 7.7 8.3 7.8 7.3 25.0 7.9 12.6 10.0 12.3 9.4 11.5 9.6
Total 143 36 179 330 12 342 2597 30 316 759 78 100
In rural areas, people preferred home deliveries either because they perceived institutional
deliveries to be prohibitively too far from the village (40.5%), did not get time to plan for the trip to
the hospital (55.3%), felt it unnecessary because alternate arrangement at home was equally
good if not better and no one to company (12.3%). In urban areas, the reasons were more
polarized with 48% preferring home deliveries to institutional deliveries because of the time issue
(emergency delivery) and 10.3% feeling that they did not feel the necessity.
61
Situating JSY in its Socio-Economic context (as narrated by health service providers,
community leaders and local officials)
Case Study: District Narsimhapur

 The district of Narsimhapur is relatively more urban when compared to Raisen and
Hoshangabad
 There is greater density of tribal population
 There is incidence of migrant population from other districts as well as other states
 There is incidence of labour colonies and slums
 Number of deliveries happen outside the purview of ASHA intervention
 In comparison to Hoshangabad and Raisen where ASHA respondents reported high
incidence of institutional delivery, albeit reportedly due to cash incentive, in this district there
are still numbers of “home” delivery reported by ASHA
 The high incidence of “home” delivery can be seen as deliveries not accompanied by ASHA,
there is incidence of mistrust on ASHA as well as on facility.
 Parts of district near to Jabalpur one of biggest city of MP
Survey also tried to capture the various prevailing practices in relation to home delivery. For a
safe delivery at home, besides trained health personnel, hygienic environment and sterilized
equipments is a must. Women who delivered at home were asked about the place used for
delivery at home, ventilation condition of room and personnel involved in conducting the delivery.
Women reported Following was done Hoshangabad Narasimhapur Raisen (%) MP (%)
at the time of last delivery (%) (%)
On the ground with clean clothes/plastic
24.6 24.9 22.8 24.0
underneath
On the ground without clothes/plastic. 45.3 61.4 64.9 59.3
On the cot with clean clothes/plastic 5.6 8.5 5.1 6.6
On the cot without cloth/plastic 20.7 4.1 2.8 7.2
Don‟t remember 2.2 0.6 0.7
Others 1.6 0.5 4.4 2.2
Data reveals that only one out of four home deliveries occurring on the ground (24.3%) with clean
clothes/plastic underneath. Only 7 percent of home deliveries are also conducted on the cot
(26.7%) with clean clothes/plastic. But a significant proportion (59.3%) of deliveries taken place
on the ground without any cloth/plastic, which is a matter of serious concern. Hoshangabad
practicing relatively good home delivery practices in comparison to Raisen and Narasimhapur.
Table 4.29: Home delivery practices, NIPI-08
State total
On the ground On the ground On the cot with On the cot Don‟t Other
with clean without clean without remember
clothes/plastic clothes/plastic clothes/plastic cloth/plastic
underneath
% % % % % %
Years of schooling
No schooling 12.2 35.2 3.0 3.8 0.5 56.0
<5 1.3 1.9 0.2 0.7 4.2
5-7 5.0 12.2 1.3 1.3 0.2 20.5
8-9 4.1 8.0 1.7 0.7 14.8
10-11 0.7 1.2 0.2 0.4 2.5
12 & above 0.7 0.7 0.1 0.2 1.9
Location of PSU
Rural 21.3 55.1 5.5 6.3 0.7 90.7
Urban 2.7 4.2 1.1 0.8 9.3
62
Wealth Index
Lowest 11.6 39.4 3.8 4.8 0.4 61.5
Second 4.2 7.6 0.7 0.7 0.2 13.7
Middle 2.6 6.1 0.7 1.2 10.9
Fourth 3.8 3.0 0.4 0.2 7.5
Highest 1.8 3.1 1.0 0.2 0.1 6.3
Total N 201 496 55 60 6 153
As given in the table 4.2.13, bring in notice that a large number of the women who had home
delivery did not follow standard precautionary measures. This will leads plenty of health problems
for mother and child as well.
Table 4.30: Person who conduct delivery at home, NIPI-08

Delivery District State total
Specification Hoshangabad Narsimhapur Raisen
% % % % % % % % % % % %
Person Conducted Delivery
Mid Wife/LHV 2.8 0.6 0 0 61.9 0.7 0.0 0.6 0.3 1.3 0.4
Trained Dai 21.7 55.6 28.5 34.5 25.0 0 38.5 20.0 36.7 33.6 37.2 33.9
Untrained Dai 63.6 27.8 56.4 47.0 16.7 0 46.9 70.0 49.1 50.1 42.3 49.3
ASHA 1.4 0.0 1.1 0.6 0 0 0.3 0 0.3 0.7 0 0.6
ANM 0.7 2.8 1.1 4.8 16.7 17.3 2.8 6.7 3.2 3.3 6.4 3.6
Family Member 7.0 8.3 7.3 26.7 50.0 76.7 12.6 3.3 11.7 17.7 12.8 17.2
Relatives/friends 2.8 11.1 4.5 3.0 33.3 26.6 5.2 3.3 5.1 3.8 11.5 4.5
Any Other 4.9 2.8 4.5 1.2 0 0.7 2.8 6.7 3.2 2.5 3.8 2.6
Total 143 36 179 330 12 342 75 30 316 759 78 837
Untrained Dai‟s in both rural and urban area conducted most (49.3%) of the home deliveries.
However trained Dais conducted 33.9% of the deliveries. Overwhelmingly in Narshimhapur
district it was a family member/other relatives who performed the delivery at home. This is across
both urban and rural areas.
As come out from the data, most of the deliveries were conducted by untrained dais, which
clearly gives a feeling, that they were not aware of safe delivery practices.
Table 4.31: Reasons behind choosing a specific person to conduct the delivery, NIPI-08
Specification District State total
% % % % % % % %
Why did you choose the person to conduct delivery
Past Experience 46.9 27.8 43.6 41.7 36.4 53.3 41.5 39.7
Economical 0.7 2.8 6.4 8.3 15.7 6.7 8.8 5.1
Safe Delivery 25.2 50 38.2 8.3 30.4 16.7 32.8 30.8
Reliable 1.4 2.8 4.2 8.3 4.2 3.3 3.7 3.8
Behaviour of the service provider 4.9 0 1.5 16.7 3.1 13.3 2.8 7.7
Recommended 11.2 8.3 0.9 8.3 2.1 0 3.3 5.1
Others 9.7 8.3 5.2 8.4 8.1 6.7 7.1 7.8
Total 143 36 330 12 103 30 759 78
The above table clearly indicates that across all three districts and across both urban and rural
areas, the choice of a person to make the delivery is taken on the basis of past experience (37%)
or because it is clearly perceived that their experience would result in a safe delivery (39%).
The following section looks at the different steps followed during the delivery process at home by
the person who delivered the baby.
63
Table 4.32: The delivery process, NIPI-08

Indicator All NIPI Districts
Rural Urban Total

% % %
Was she/he contacted before the labor pain started?
Yes 45.5 46.2 42.1
No 53.9 52.6 5.5
Don't know 0.6 1.2 52.4
Did she/he mention the requirements before attending the delivery?
Yes 53.5 60 1
No 46.5 40 99
Don't know
Did the person who attended the delivery wash his/her hands before attending the delivery?
Yes 71.9 76.9 74.4
No 17.3 6.4 11.85
Don't know 10.8 16.7 13.75
What was used for washing?
Water only 17.2 21.7 19.45
Soap 78.2 75.0 76.6
Ash/Mud 1.5 1.05
Don't know 2.4 3.3 2.1
Other 0.7 0.8
Total 546 60 606
As shown in the data more than half (52.1%) of the women did not remembers that when did the
person who conduct delivery was contacted, while 4.1 % of the women responded the person
was contacted before initiation of Labour pain. Only 32.8% of the provider washes their hands
before conducting delivery, most of the provider used soap followed by ash/mud.
For all those women who could recall about the issue, most had reported that the healthcare
provider told her/family members the requirements for the delivery before attending the
household.
Table 4.33: Cost incurred in home delivery, NIPI-08

Rupees Hoshangabad Narsimhapur Raisen State total
N 270 24 294 134 78 212 171 38 209 575 140 715
Mean 963 2,539 1,266 739 925 745 1,435 1,771 1,469 1,035 1,982 1,119
Median 550 500 500 400 750 400 1,000 2,000 1,000 500 1,000 550
The average (or mean) cost incurred on institutional deliveries came to around Rs.1, 119, while
the median value was Rs.550. The differences between urban and rural areas were not quite
pronounced in any of the districts.
Table 4.34: Nature of advice received, NIPI-08
Indicator State total
Rural Urban Total
N % N % N %
New born care practices 198 25.8 31 22.2 229 27.1
Breast Feeding practices 164 21.4 31 26.9 195 23
Immunization 93 12.1 11 13.9 104 12.3
Routine check up 65 8.5 8 9.1 73 8.6
Spacing method 14 1.8 4 5.1 18 2.1
Any Other 3 0.4 4 4.3 7 0.8
No Advice was given 488 30 30 18.5 518 26.1
Total 767 100 79 100 846 100
In case of home deliveries, we gives advise

on Brest feeding and child care practices to
the mother and family members.
Rakhi singh AWW, mandideep block Raisen 64
district
In a little more than two third cases, the attendants did not give advice immediately after delivery.
Considering that in most cases a formally trained attendant did not conduct the delivery, receiving
wrong advice from them is certainly an area of concern. This is all the more so because 63% of
the mothers had reported that they were advised on breastfeeding practices and 54% on new
born care practices. Both issues are very critical during the postpartum phase and it is advisable
for the program to take cognizance of the fact that it has to ensure that even informal and
untrained attendants need to be well aware of medically sound advice.
4.4 Postnatal care

Under this section, the responding women were asked for the timing of their first PNC checkup,
number of times PNC was received, type of service provider and place where the PNC was
provided.
Table 4.35: Timings of first postnatal care, NIPI-08
Timings District State total

of First Hoshangabad Narsimhapur Raisen
PNC Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
<4 Hrs 47.9 40.2 45.6 2.9 11.8 4.5 24.5 27.5 25.1 23.8 29 25
4-23 Hrs 2.7 4.2 3.1 1 0.8 3.7 1.4 3.3 2.4 2.3 2.4
1-2 days 8.1 14.6 10.1 15.3 17.9 15.7 13.7 21.3 15 12.6 17.3 13.6
3-41
days 1.1 3.7 1.9 3.9 9 4.8 4.6 5.7 4.8 3.3 5.6 3.8
>41
days 0.7 0.6 0.7 1.6 0.9 1.5 1 1.9 1.2 1.1 1 1.1
DK/CS 1.1 2.2 1.4 3.7 5.7 4.1 3 1.9 2.8 2.7 3.1 2.8
No
Checkup 38.4 34.5 37.2 71.6 54.7 68.6 49.5 40.3 47.8 54.1 41.7 51.3
Total N 828 356 1184 990 212 1202 974 211 1185 2792 779 3571
An overwhelming 70% of all responding mothers had reported that they had not received any
PNC checkup. This figure was 73% in rural areas and 58% in urban areas. There were district
level variations as well. In Raisen urban, ore than 50% had reported to have a PNC checkup
within 4 hours of delivery and only 27% had reported not having had any checkup. The situation
was just the reverse for rural Raisen. The situation in Hoshangabad was dismal with as high as
85-86% of respondents across both urban and rural areas had reported not having received any
PNC. The situation in Narsimhapur was also bad with 75% reporting no PNC.
Table 4.36: Number of times PNC received, NIPI-08
PNC State total
Rural Urban Total

% % %
1 45.0 40.9 43.6
2 27.9 21.4 25.7
3+ 27.1 37.7 30.7
Total 2792 779 3571
As shown in table 4.36, less than half had received only 1 PNC but this was by and large the
majority category. Over a third had received 3 or more PNCs and around a quarter had received
only two.
65
Most of the PNC was provided by the healthcare personnel/doctor and in this regard, there was
marginal difference between urban and rural areas (88 - 95%) and Hoshangabad (63% each) but
quite a difference in Narshimhapur district (96 -
73%). The roles of the ANM/nurse/midwife in ….we encourage women to go for PNC but they do
providing PNC seem to have been confined to not willing to go for it ……sangeeta sahu, AWW
the district of Hoshangabad alone. pipariya , Hosangabad
The PNC checkup either took place a government hospital, PHC or a private clinic. In less than
10% of the case was the PNC administered at home by trained personnel coming over.
Not going for PNC is one of major issues of concerns and also effect success of the
programme, most of the family members do not feel necessity of it and another important
aspect is no any incentive given for the PNC.
66
Chapter 5
Newborn Care
5.1 Preamble
Care provided during the prenatal and neonatal periods is critical to ensuring the health of mother
and baby. Maternal health and newborn health are inextricably linked. Newborn Care comprises:
(a) Basic preventive newborn care such as care before and during pregnancy, clean delivery
practices, temperature maintenance, eye and
cord care, and early and exclusive breastfeeding …I am 11 pass..I have been ANM for past 15
on demand day and night; (b) Early detection of years …. my village is 8 Km far from this
problems or danger signs (with priority for sepsis Sub Centre … I travel with one of my
and birth asphyxia) and appropriate referral and colleague who is a male health worker …I
care-seeking. come on his bike… I cover 18 villages under
my SC with a total population of about
In this chapter, we shall limit ourselves to the 9118… I take help from ANM and AWW to
understanding of breastfeeding practices among outreach vaccines. But most of the times
women in the program districts we have to go alone to the interiors of
of Madhya Pradesh. villages… these villages have dense forests
and wild animals…we need transport
The following section deals with the extent to facility…Jitendra Glutke, ANM, village Polah,
which the responding mothers were aware of Block Mandidip (Raisen)
the importance of the issues discussed above,
the source of their knowledge and their actual behaviour regarding breastfeeding.
5.2 Birth weight
…I have six main duties…registration, It was confirmed by 91.8% of the eligible women
immunization, give fortified foods, respondents that their last child was not weighed
commemorate birthday of the child from at birth. The situation was the same across urban
1 to 6 years of age, weigh the child and and rural areas. Out of these 60 cases where the
grade him/her and finally refer the sick mother could recall that weight was measured,
to the hospital…all the immunization is there were only 48 cases where this could be
done by ANM…I grade the children after validated through the card available with the
weighing them… - Rajjobai Prakashchand household. The recorded birth weight of the
Bairagi, AWW, village Niwari, Sohagpur, children as elicited through the card is tabulated
Hoshangabad below. Since the number of cases was limited, a
decentralised analysis by background variables
has not been attempted.
Table 5.1: Recorded weight of baby, NIPI-08
Hoshangabad Narsimhapur Raisen State total

Indicator <2.5 Kg >=2.5 Kg <2.5 Kg >=2.5 <2.5 Kg >=2.5 Kg <2.5 Kg >=2.5 Kg
Kg
N % N % N % N % N % N % N % N %
*Total number of 2 15. 1 84. 2 11. 15 88 2 12. 1 87. 6 12. 4 87.
women 3 1 6 7 5 4 5 5 2 5
* Women who showed cards.
67
…we don‟t have necessary ASHA kits DLHS 2 shows that less than three fifth of the
equipments…we have requested ANM children in MP were underweight (weight for
twice now …but no answer– ASHA, age <-2SD), while about one fourth percent
Kusum bai, Rajender Thakur…Belkhedi, were severe underweight (weight for age <-
Gadarvara block (Narsingpur) 3SD). Raisen and Hoshangabad districts
…We don‟t get ASHA kits..through ANM reported less than half (Annexure 18). But the
we get only IFA tablets, ORS packets reported underweight for Narsimhapur was
and FP pills – ASHa, Smt. Shanti much higher (only 59%). At juxtapose, NIPI
Bai…Kumhroda..Kareli block (Narsingpur) Phase II survey reported that out of the 60
cases where the weight could be verified from
the card, 12.5 were less than 2.5 kg in weight
while the rest were 2.5 kg or more. The trend is fairly similar across all three districts where
babies weighing at least 2.5 kg ranged between 84% and 88%.
Table 5.2: Mother‟s perception about size of newborn, NIPI-08

Size of the baby Rural Urban Rural Urban Rural Urban Rural Urban
N % N % N % N % N % N % N % N %
Smaller than average 42 28.8 14 37.8 121 36.1 5 41.7 126 44.1 10 33.3 289 37.7 29 36.7
Larger than the average 72 49.3 19 51.4 195 58.2 7 58.3 131 45.8 11 36.7 398 51.9 37 46.8
Average 31 21.2 4 10.8 15 4.5 26 9.1 8 26.7 72 9.4 12 15.2
Can not define 1 0.7 4 1.2 3 1.0 1 3.3 8 1.0 1 1.3
Total 146 100 37 100 335 100 12 100 286 100 30 100 767 100 79 100
…after birth…first thing we advise mothers is to We have already ascertained that very
breastfeed the child..,we then weigh the few babies were actually weighed at
newborn..,but if the child is LBW then we refer the birth. However, the research did give
newborn to PHC – ANM, Sujata S. the opportunity to the eligible mothers
Lansoge…Gautampur village, Obedullaganj block to recall and record whether they
(Raisen) thought the size of the newborn was
smaller, larger or as per average.
..If the newborn is below 2.5 Kg.. we consider the
child LBW…ASHA, Pushplata thakur, Chawarpatha
Block (Narsingpur) It can be seen from the table above
that overall, a high percentage (47%)
..Every month we weigh and measure the height of of the mothers across urban and rural
the babies…we check growth chart and grade....if locations thought that their babies
the baby is LBW then we give Vitamin A and were larger than the average.
advise mothers to take nutrition food...AWW, Smt Although, across the rural and urban
Muni Bai, Binaka Village, Goharganj block (Raisen). locations it was observed that a low
percentage of mothers (nearly 15%)
..We have weighing machines ..AWW, Smt.Saroj perceived that their babies were of
Swami ,Gategoan block (Narsingpur) average or normal size.
68
5.3 Neonatal checkups
Table 5.3: Timing of first neonatal check-up, NIPI-08
Rural Urban Total

N % N % N %
<6 Hrs 665 23.8 226 29.0 891 12.1
6-23 Hrs 68 2.4 18 2.3 86 6.9
1-2 Days 351 12.6 135 17.3 486 1.4
3-4 Day 93 3.3 44 5.6 137 62.4
5-6 Days 32 1.1 8 1.0 40 0.2
Week or more 75 2.7 24 3.1 99 0.1
DK/CS 11 0.4 1 0.1 12 10.5
No checkups 1,497 53.7 323 41.6 1,820 6.4
Total base 2,792 100 779 100 3,571 100
Over 54% in rural areas and nearly 42% in urban areas had reported that neonatal checkups did
not take place in case of their newborn. In rural areas, a little over 23% of the mothers did report
that neonatal checkups did take place and it happened within the first 6 hours of childbirth.
Similarly, in urban areas, a little over 29% of the mothers did report that neonatal checkups did
take place and it happened within the first 6 hours of childbirth. Therefore, it is quite apparent that
in the program district neonatal checkups either did not happen or happened within the first 6
hours of birth.
Table 5.4: Time of first neonatal check-up by districts, NIPI-08

Rural Urban Rural Urban Rural Urban
N % N % N % N % N % N %
<6 Hrs 397 47.9 143 40.2 29 2.9 25 11.8 239 24.5 58 27.5
6-23 Hrs 22 2.7 15 4.2 10 1 36 3.7 3 1.4
1-2 Days 67 8.1 52 14.6 151 15.3 38 17.9 133 13.7 45 21.3
3-4 Day 9 1.1 13 3.7 39 3.9 19 9 45 4.6 12 5.7
5-6 Days 6 0.7 2 0.6 16 1.6 2 0.9 10 1 4 1.9
Week or more 9 1.1 8 2.2 37 3.7 12 5.7 29 3 4 1.9
DK/CS 7 0.8 1 0.3 1 0.1 3 0.3
No checkups 311 37.6 122 34.2 707 71.5 116 54.7 479 49.2 85 40.3
Total base 828 100 356 100 990 100 212 100 974 100 211 100
District wise analysis seems to indicate that the situation in rural Narsimhapur is quite bad with
71.4% of mothers indicating no checkups. The situation is also bad in rural Raisen where 49.2%
of mothers had claimed likewise. In fact, the urban situation is both districts is also quite dismal,
with nearly 54% of mothers and 40% of mothers respectively indicating no checkups for their
newborns. The situation in Hoshangabad district is marginally better, at least in the rural locations
where only 37 %had reported no checkups and 47% had reported the first check-up within 6
hours of delivery.
5.4 Breastfeeding and supplementation
This section looks at breastfeeding …in my village the traditional practice was to
practices among the eligible women, wrap the new born in cloth…the baby is
the attitude and practice pertaining to massaged with oil…bathed only three days after
feeding of prelacteal liquids and birth…the mother takes a bath after five days of
delivery…we try to tell them of proper health
practices…mothers usually discard the
colostrums…we educate mothers to give the first
milk… - Sakunbai Rajak, AWW, village Manakwara,
Gadarwara, Narsighpur 69
period of exclusive breastfeeding and introduction of supplementary feeding.
Table 5.5: Breastfeeding practices, NIPI-08
Indicator Hoshangabad Narsimhapur Raisen

Rural Urban Rural Urban Rural Urban
Mother breastfeed the N % N % N % N % N % N %
child
Yes 819 98.9 354 99.4 971 98.1 206 97.2 955 98.0 206 97.6
No 9 1.1 2 0.6 19 1.9 6 2.8 19 2.0 5 2.4
Total 828 356 990 212 974 211
Anybody helped in initiating the breastfeeding
Yes 511 62.4 262 74.0 307 31.6 69 33.5 589 61.7 121 58.7
No 308 37.6 92 26.0 664 68.4 137 66.5 366 38.3 85 41.3
Total 819 354 971 206 955 206
Sources helped in initiating breastfeed
Government Doctor 12 2.3 8 3.1 1 0.3 9 1.5 7 5.8
Private Doctor 14 2.7 11 4.2 19 6.2 8 11.6 86 14.6 31 25.6
Nurse 121 23.7 53 20.2 47 15.3 19 27.5 39 6.6 4 3.3
ANM/ASHA/LHV 19 3.7 3 1.1 11 3.6 1 1.4 71 12.1 12 9.9
Dai 6 1.2 6 2.3 7 2.3 285 48.4 45 37.2
Mother/ Mother-in-law 280 54.8 139 53.1 185 60.3 33 47.8 73 12.4 17 14
Friends/Relatives 55 10.8 38 14.5 31 10.1 5 7.2 6 1.7 1 0.8
Others 4 0.8 4 1.5 6 1.9 3 4.5 9 2.7 7 3.4
Total 511 262 307 69 589 121
Status in terms of child feeding practices in MP was recorded better than the country as a whole
and there is improvement since DLHS-2 in the state (Annexure 17). About 43% of the children
below 3 years were breastfed within one hour of birth. While NIPI Phase II indicates that nearly all
women had breastfed their child. About three fifth to two fourth of women from Raisen and
Hoshangabad had admitted that someone had helped them out in initiating breastfeeding. Only
about one third of women in Narsimhapur admitted that someone had helped them in initiating
breastfeeding.
Many sources in Hoshangabad and Narsimhapur districts have been responsible for this
initiation. In rural and urban areas, it has been primarily the Mother/Mother in law, nurse and
friends/ relatives (10%). While Dai followed by private doctor were major source in Raisen that
has helped in initiating the breastfeeding.
At this juncture, it would be worthwhile to see whether or not time of initiation of breastfeeding
was influenced by various background characteristics of the mother. The following section
elaborates.
So far as the time of initiation of breastfeeding is concerned, baseline data reveals that of the total
mothers who have ever breastfed their child, 36 percent started breastfeeding within one hour of
birth and (43%) breastfed their child after one hour but on the same day in all the three districts
together. District wise analysis shows that Raisen has the highest percentage (41%) of mothers
who started breastfeeding their child within one hour of birth followed by Hoshangabad (36%) and
Narsimhapur (31%).
70
Figure 5.1: Time of initiation of Breast-feeding
Mothers who have ever breastfed their child

49
50
43 43
41
37 36
40 36
31
Percent
30
23 22
21 21
20
10
0
Hoshangabad
N:1173 Narshingpur
N:1177 Raisen
N:1161 N:3511 MP
Within one hour after birth
After one hour but within same day
After more than 24 hours
Table 5.6: Initiation of breastfeed and gender of child, NIPI-08
Immediately Same day after 1-3 days After 3 days Still no

within an hour of an hour of birth breastfed
birth
% % % % %
Boy 35.2 42.0 14.3 6.7 5.6
Girl 34.7 41.6 14.4 7.3 0.1
It is quite clear that gender of the child did not have any influence on the time of initiation of
breast milk.
Table 5.7: Initiation of breastfeed and education of mother, NIPI-08
Indicator Immediately Same day 1-3 days After 3 days Still no breastfed
within an after an hour
hour of of birth
birth
% % % % %
No
33.9 41.6 15.4 0.1
schooling 9
<5 36.6 44.4 6.5 12.4
5-7 36.1 45.1 6.0 12.7 0.1
8-9 36.3 43.3 6.1 14.3
10-11 39.9 39.1 3.8 16.8 0.4
12 & Above 35.5 41.5 5.9 16.1 0.8
71
From the above table it is quite clear that even education of mother was not a determinant of
initiation of breastfeeding.
Table 5.8: Initiation of breastfeed and number of live children including index child , NIPI-08
Indicator Immediately Same day 1-3 days After 3 days Still no

within an after an hour breastfed
hour of of birth
birth
Birth Order % % % % %
1-2 35.5 42.4 6.8 15.1 0.2
3-4 35.3 43.9 8.2 12.6 0.1
5+ 36.3 39.2 5.2 19.3
The conclusion here is in the same lines as the before. There is no relationship between the birth
order of the index child and the time of initiation of breastfeeding.
Table 5.9: Feeding of prelacteal liquids, NIPI-08

N % N % N % N % N % N % N % N %
Exclusively breastfeed 12 7.5 1 1.1 6 2.9 1 2.3 24 10.6 1 2.6 42 7.1 3 1.8
Milk (other than breast milk) 100 62.1 60 67.4 165 80.9 35 81.4 150 66.1 23 59 415 70.1 118 69
Plain water 3 1.9 1 1.1 1 2.3 5 2.2 2 5.1 8 1.4 4 2.3
Sugar or glucose water 1 0.6 3 3.4 2 1 1 2.3 11 4.8 14 2.4 4 2.3
Sugar-salt-water solution 1 0.6 1 0.2
Infant formula 10 6.2 7 7.9 10 1.7 7 4.1
Tea 4 2.5 1 1.1 2 0.9 1 2.6 6 1 2 1.2
Honey 7 4.3 4 4.5 26 12.7 4 9.3 6 2.6 6 15.4 39 6.6 14 8.2
Janam ghutti 2 1.2 1 0.4 1 2.6 3 0.5 1 0.6
Other 21 13.1 12 13.5 5 2.5 1 2.4 28 12.4 5 12.7 54 9 18 10.5
Total 161 89 204 43 227 39 592 171
Milk other than breast milk (usually goat‟s milk) and infant formula was being given to neonates
by mothers as part of prelacteal feed. There was also a practice of feeding honey in all the NIPI
districts. Overall, it was observed that the practice of introducing prelacteal liquids was practiced
in both urban and rural locations.
Table 5.10: Period of exclusive breastfeeding by background variables , NIPI-08

Indicator < 6 months 6 months and more months
Boys 722 34.5 374 17.9
Girls 637 30.5 357 17.1
Total 1,359 65 731 35
Age of the Respondent (in Years)
15-18 34 1.6 9 0.4
19-21 283 13.5 165 7.9
22-25 615 29.4 317 15.2
26-30 321 15.4 173 8.3
31-40 101 4.8 62 3.0
41-49 5 0.2 5 0.2
Total 1,359 65 731 35
Years of schooling
No schooling 613 29.3 269 12.9
<5 64 3.1 43 2.1
5-7 270 12.9 156 7.5
8-9 245 11.7 153 7.3
10-11 86 4.1 53 2.5
12 & Above 81 3.9 57 2.7
Total 1,359 65 731 35
72
Indicator < 6 months 6 months and more months

Number of Live Children
1-2 866 41.4 498 23.8
3-4 407 19.5 182 8.7
5+ 86 4.1 51 2.4
Total 1,359 65.0 731 35.0
Location of PSU
Rural 1,097 52.5 544 26.0
Urban 262 12.5 187 8.9
Total 1,359 65 731 35
Wealth Index
Lowest 729 34.9 311 14.9
Second 185 8.9 104 5.0
Middle 145 6.9 99 4.7
Fourth 136 6.5 105 5.0
Highest 164 7.8 112 5.4
Total 1,359 65 731 35
In this section, we looked at the proportion of mothers who had exclusively breastfed their child
for a period of at least 6 months. For this analysis, only mothers of children beyond 6 months of
age were considered and all mothers who were currently breastfeeding but had children who
were younger were not considered.
According to DLHS3, a higher proportion of 78.4 % of mothers had discontinued exclusive

breastfeeding before 6 months in MP than those who had continued beyond 6 months (21.6%).
Similarly in NIPI survey, overall, a higher proportion of mothers had discontinued exclusive
breastfeeding before 6 months (65%) than those who had continued beyond 6 months (35%).
However, the gender of the index child was not a differentiator as far as duration of exclusive
breastfeeding was concerned. In fact, for all other background variables, viz. location of PSU,
education of mother, economic profile of family and number of live children, there seems to have
been no significant correlation or trend.
Summary observations
The stress in PNC was on immunization and providing „fortified‟ foods to the malnourished. It was
observed that there was good division of duties between the local operatives, viz., the ASHA and
the ANM. PRI representatives and community leaders had greater role in defining the areas of
functioning of these service providers. The ANM and local operative interaction was of a smooth
and complementary order. There was little in way of conflict of interest between the two.
It was almost a kind of „informal‟ understanding that ANM with active support of ASHA and to a
lesser extent with that of AWW was in charge of ANC, ASHA on her part was in charge of
„institutional‟ delivery and lastly AWW with „infrastructure‟ of the Anganwadi center was in charge
of PNC and new born care.
Local practices highlight the fact that feeding of first breast milk was not given to the new born.
There was also some apathy towards PNC, particularly for getting the baby weighed. It was
observed across service provider category in the districts that immunization remained a major
task confronting for government program delivery personnel.
…the activities of a month are fixed in advance…first

Tuesday there is immunization and Mothers‟
meeting…second Tuesday new born check up…third
Tuesday child health check up…fourth Tuesday is „kishori
balika divas‟ and registration of pregnant women…we are
trained with topics mainly of new born care and mother
health issues…we are also told how to give „informal‟
education to children… - Sita Uday Singh Yadav, AWW,
village Hatwas, Pipariya, Hoshangabad
73
Chapter 6
Child Morbidity and Treatment
This chapter provides details of the incidence of Diarrhoea, ARI and fever, both period prevalence
as well as point prevalence. It also explores the treatment seeking behaviour of the mothers at
the time of illness and the nature of feeding practices during the incidence.
6.1 Prevalence of illness in children under study
The following section looks at the prevalence of child morbidity (diarrhoea and fever in last two
weeks) at the day of visit by the survey team.
Table 6.1 Prevalence of illness in children under study, NIPI-08

Rural Urban Rural Urban Rural Urban Rural Urban Total
% % % % % % N % N % N %
% of children with diarrhoea in last two weeks
Yes 13.5 9.3 5.9 9.0 17.5 10.9 340 12.2 75 9.6 415 11.6
% of children with fever in last two weeks
Yes 16.3 16.3 10.7 13.7 23.0 23.7 465 16.7 137 17.6 602 16.9
As according to NFHS3, prevalence of ARI among children in India was about 16 percent while it
was more of 29 percent in MP. Similarly for NIPI survey (NIPI 08), prevalence of ARI among
children in MP was reported at 16.9 %.
More than two third of the children for less than 5 years of age had diarrhoea during the two
weeks prior of the survey at State level. However NIPI survey was reported to be slightly better
with about 11.6% of children less than 2 years of age had diarrhoea during the two weeks prior to
survey. (Table 6.1 and Table 6.2)
Table 6.2: Prevalence of illness in children under study

MP India
Indicator NFHS-3 NFHS-2 NFHS-1 NFHS-3 NFHS-2 NFHS-1
(2005-06) (1998-99) (1992-93) (2005-06) (1998-99) (1992-93)
Prevalence of ARI 29 30 Na 24 16 10
Prevalence of Diarrhoea 69 Na Na 56 Na Na
Source: NFHS 2 and 3 (fact sheets)
6.1.1 Point prevalence of diarrhea and illness
Table 6.2 presents that overall the diarrhoea point prevalence rate (at the time of the survey
contact) was 1.7% while illness was slightly higher of 2.4 %.
Table 6.2: Point prevalence of diarrhoea and illness, NIPI-08

Morbidity Hoshangabad Narsimhapur Raisen State total
% % % % % % % % %
Diarrhoea 0.5 0.1 0.2 0.1 0.8 0.1 1 0 1.7
Fever only 0.4 0.2 0.2 0.1 0.7 0.2 1.4 0.5 1.9
Cough only 1.0 0.3 0.3 0.1 1.0 0.4 2.3 0.8 3.1
Both fever and cough 0.1 0.1 0.4 0.2 1.1 0.4 2.0 0.4 2.4
74
6.1.2 Diarrhoea
The period prevalence for diarrhea among children was as part of this study. Overall the period
prevalence rate (last 2 weeks prior to the survey contact) was 11.6%, which varied between
12.2% in rural areas and 9.6% in urban areas. The period prevalence levels were highest in
Raisen (17.5% rural and 10.9% urban) and lowest in Narsimhapur district (5.9% and 9%
respectively).
Table 6.3: Period prevalence of diarrhoea, NIPI-08

% % % % % % N % N % N %
% of children with diarrhoea in last two weeks
Yes 13.5 9.3 5.9 9.0 17.5 10.9 340 12.2 75 9.6 415 11.6
No 86.5 90.7 94.0 90.6 82.5 88.6 2,451 87.8 702 90.1 3,153 88.3
DK 0.1 0.4 0.5 1 0.0 2 0.3 3 0.1
Total 100 100 100 100 100 100 2,792 100 779 100 3,571 100
6.1.3 Awareness of Diarrhoea
Diagram 6.1: Type of practices to be followed if child gets diarrhoea*
Do not Know Give ORS

21% 26%
Salt and sugar

Continue
solutions
Normal
Any Other (Specify) food
5%
32% 5%
Continue
Give plently of
Breastfeeding
fluids
23%
2%
*Last two weeks prior to the survey
Around 20% of mothers had continued to breastfeed during this process. Around 4% had made
their own salt and sugar solution and given to the child. (Annexure A9)
The propensity to give ORS to a child suffering from diarrhoea does not seem to change with the
education of the mother as the data does not capture any definitive trend in usage.
75
6.1.4 Treatment of Diarrhoea
The following section shows the percentage of women who sought treatment whose child
suffered from diarrhoea and source of treatment, according to place of residence and availability
of health facility in program districts.
Table 6.4: Advice received from ANM or health worker, NIPI-08

State total
Indicator Rural Urban Total
N % N % N %
Yes 126 37.1 28 37.3 154 37.1
No 214 62.9 47 62.7 261 62.9
Total 340 100 75 100 415 100
Out of the 415 cases of diarrhoea in the previous 2 weeks prior to the survey contact, only 154
cases (37.1.%) where the ANM or any other health worked had given advice on what needs to be
done in terms of treatment.
However, it must also be noted that 62.9% of the mothers with a child who were suffering from
diarrhoea did not seek any advice or go for external treatment.
Table 6.5: Place of treatment, NIPI-08

Place of Diarrhoea Treatment NIPI states
Rural Urban Total
N % N % N %
Government health facility
Government /Municipal 17 6.7 9 15.8 26 8.4
Government Dispensary 1 0.4 1 0.3
CHC/ Rural hospital 1 0.4 1 1.8 2 0.6
PHC 23 9.1 8 14.0 31 10.0
SC 24 9.4 4 7.0 28 9.0
Govt. AYUSH/Clinic 5 2.0 5 1.6
Private health facility
Private Ayush Hospital Clinic 21 8.3 3 5.3 24 7.7
Private Hospital/Clinic 141 55.5 31 54.4 172 55.3
Other 8.2 3 1.7 29 7.1 8.2
Total 254 100 57 100 311 100
According to NFHS3, more than three fifth (63.9%) of the children in MP were taken to a health
facility when they had diarrhoea in the two weeks prior to the survey. While Phase 2 survey
reveals that the usual place for diarrhoea treatment was the private hospital. In nearly 66% of the
instances, the treatment was sought after a day or two since the beginning of the incident.
Some of the other observations pertaining to

action taken during diarrhoea were as follows: ….. during home visits, if we found any child
fall sick due to Diarrhoea , we advice mother
 3/4th of the women had not discontinued to give ORS and other liquid diet. …Mamta
breastfeeding while their child was suffering Bhandari , AWW , Kasla block Hosangabad
district
from diarrhoea. (Annexure A10)
 During the incidence, most mothers either
reduced the amount of liquid given to the child or continued to give them the same amount as
normally done.
 Food intake was also reduced with 61% mothers saying they did so. (Annexure A10)
 311out of the 415 mothers whose children had diarrhoea had been given advice on treatment
and in most cases it constituted of importance of taking ORS. In most cases the advice was
given by the government doctor, private doctor and the ANM/ASHA/LHV (Annexure A10)
76
6.2 Acute Respiratory Infection
6.2.1 Knowledge about pneumonia
An attempt was made to understand the awareness level of term pneumonia, and mother‟s
awareness on symptoms of pneumonia. This is presented in the table 6.5 and figure 2.
Table 6.6: Proportion of mothers aware of the term pneumonia, NIPI-08

% % % % % % N % N % N %
Yes 51.9 57.6 37.4 47.2 42.6 37.0 1,215 43.5 383 49.2 1,598 77.1
No 48.1 42.4 62.6 52.8 57.4 63.0 1,577 56.5 396 50.8 1,973 22.9
Total 100 100 100 100 100 100 2,792 100 779 100 3,571 100
Across the districts, less than one fourth of women were not aware of the terms “pneumonia”.
Apart from Hoshangabad where around 53% of the mothers were aware of the term pneumonia
in the other two districts awareness was lower, ranging between 39% and 42%. The awareness
in rural areas in general was very low, as low as 37% in Narsimhapur district.
Figure 2: Awareness of symptoms of pneumonia
80
70 Difficulty in Breathing
60 Chest Indraw ing

Not able to take feed
50
Exclusive Drow sy
40
Pain in chest
30
Condition gets w orst
20
Wheezing
10
Rapid Breathing
0
Others
Rural Urban Total
Of those who were aware of pneumonia, most (65%) knew that it was accompanied by chest in
… whenever the child faces problem in drawing, difficulty in breathing (49%) rapid
breastfeeding or is suffering from breathing (33%), pain in chest and wheezing
pneumonia, …yellow fever…we tell (28 %).
mothers to come with us to health
facility….but mothers prefer to go with Prevalence of pneumonia in rural areas of the
AWW/ other health workers…they think program districts combined was 25.6% (ever
they are very old and trustworthy…we feel suffered) while it was 22.5% in the urban
bad. ASHA, Rukmani Patel, Jhamar, village areas.
(Narsingpur)
Overwhelmingly almost everyone had
consulted a qualified doctor for treatment of
their child. (See table below)
Table 6.7: Treatment of pneumonia, NIPI-08
77
Sought treatment Rural Urban Rural Urban Rural Urban Rural Urban Total
N % N % N % N % N % N % N % N % N %
Yes 197 98.5 84 98.8 227 96.6 41 97.6 269 95.7 46 95.8 693 96.8 171 97.7 864 97
No 3 1.5 1 1.2 8 3.4 1 2.4 12 4.3 2 4.2 23 3.2 4 2.3 27 3
Total 200 100 85 100 235 100 42 100 281 100 48 100 716 100 175 100 891 100
Percentage distribution of women who seek treatment by
Doctor 190 96.4 82 97.6 223 98.2 41 100 262 97.4 44 95.7 675 97.4 167 97.7 842 97
ANM/Nurse/LHV 1 0.5 1 1.2 2 0.9 4 1.5 1 2.2 7 1 2 1.2 9 1
UMP/RMP 4 2 1 0.4 5 0.7 5 1

Relative/Friends 1 0.5 2 0.9 1 2.1 3 0.4 1 0.6 4 0
Chemist/Medical 1 0.6 2 0.7 3 0.5 3 1
shop
Ayush practioner 1 1.2 1 0.6 1 0
Total 197 100 84 100 227 100 41 100 269 100. 46 100. 693 100 171 100 864 100
6.3 Fever
6.3.1 Illness with fever and treatment seeking behaviour
The period prevalence rate for fever among children was calculated as part of this study. Overall
the period prevalence (last 2 weeks prior to the survey contact) was 16%, which varied between
16.6% in rural areas and 17.5% in urban areas. The period prevalence levels were highest in
Raisen urban (23.6) and lowest in Narsimhapur district rural (10.7%).
Table 6.8: Incidence of fever among children in last 2 weeks prior to survey contact, NIPI-08

% % % % % % N % N % N %
Yes 16.3 16.3 10.7 13.7 23.0 23.7 465 16.7 137 17.6 602 16.9
No 83.6 83.7 89.2 86.3 76.8 75.8 2,323 83.2 641 82.3 2,964 83
DK 0.1 0.1 0.2 0.5 4 0.1 1 0.1 5 0.1
Total 100 100 100 100 100 100 2,792 100 779 100 3,571 100
Table 6.9: Duration of treatment sought during illness, NIPI-08
Indicator State total

Rural Urban Total
N % N % N %
Same day 62 17.4 31 28.4 93 20
2 days ago or after 248 69.8 71 65.1 319 68.7
3 - 4 days ago 31 8.6 6 5.5 37 7.9
5 - 6 days ago 4 1.1 1 1 5 1
Week or more than a week 10 3.1 10 2.4
Total 355 100 109 100 464 100
78
Nearly two third of children who suffered from illness were brought within two days of onset of
illness for treatment while one fifth of children was brought the same day of illness. (Annexure
A12)
51% of the mothers had reported that during this period, their child had both nose and chest
congestion while 31% had reported that they had runny nose and 12 % reported to have chest
congestion. (Annexure A13)
…. Despite of several efforts, mothers and family
members do not follow our instruction, if the child In 66% of the cases, the medicine for
falls sick first they give home based medical care treatment came from the private
and when the child‟s condition become more critical
hospital/clinic while only 10% had
they bring them to hospitals, ……………
…….don‟t know how to explain to the mothers ….
procured the medicine directly from the
Radha Singh, ANM, bareli block district Raisen. rural hospital/community health center.
(Annexure A12)
ASHA „without‟ her medicine kit

The ASHAs in MP were devoid of this „equipment‟ as there was no „supply of medicines‟. ASHA
activity was truncated into providing only „accompaniment‟ service to pregnant women.
6.3.2 Feeding practices during illness with fever
48% of the mothers in the urban areas had reported that they had reduced liquid intake for their
child during their illness with fever, while 24% had not done so. This was similar in rural areas
where 48% of the mothers had reported reducing liquid intake for their child. (Annexure A11)
The situation with food intake was almost exactly similar. Here 50% of the mothers in the urban
areas had reported that they had reduced food intake for their child during their bout of illness
with fever/cough, while 22% had not done so. This was similar in rural areas where 43%of the
mothers had reported reducing food intake for their child. (Annexure A11)
6.3.3 Care seeking practices during illness with fever
This sections looks at various facets of treatment and preventive measures having been taken,
money spent on treatment and problems faced if any in getting the desired treatment for the child.
Overall, 79% of the mothers had confirmed that their child was being given medicines for their
illness. 49% had confirmed that they had started giving medicines the next day of detecting the
fever. (Annexure A15)
Figure 3: Preventive measures taken for avoiding child sickness
120
100
35
80 39 37
60 29
33 32
40 20
20 12 14
17 26 19
0
Rural Urban Total
Others Keep the baby covered Purified Drinking Water Mosquito Net
79
Among those families who had taken their child to a health facility/health care provider for
treatment/diagnosis, 18% in rural and 16% did not face any problem in the process. (Annexure
A14)
30% in rural areas and 31% in urban areas had spent between Rs.200 to less than Rs.100 for
treatment of their child. 34.2 in rural areas and 36.1% in urban areas had spent between Rs.201
and Rs.500. The rest had either spent more or not spent any money at all.(Annexure A16)
Summary observation
Children from poor household (lowest wealth index) across the districts have a higher risk of child
morbidity and are less likely to get proper medical care on time.
Significant disparities in care seeking behavior are found in urban and rural children.
Children with ages 6 to 23 months have a significantly elevated risk of contracting Diarrhoea and
cough as compared to children below 6 months.
The nature of emergency health situations faced by mothers and new born by way of disease and
other morbidity issues, demand that there be some unified and concerted effort on part of all
service providers.
As has already been seen that lack of coordination at the village level health workers often leads
to available medical help not reaching the mother and child.
Regular salary and some fund assistance could make the ASHA village level dedicated single
point health „vendor‟ for numerous health initiatives and true „junior‟ partner of the ANM.
Augmenting the prestige and role responsibility of the ANM in conjunction with regularisation of
the services of ASHA can go a long way in ensuring reliable and steady health services to the
people.
80
Chapter 7
Child Immunization
7.1 Preamble
The immunisation of children against six serious but preventable diseases namely, tuberculosis,
diptheria, pertusis, poliomyelitis and measles is the main component of the child survival
programme. As part of the National Health Policy, the National Immunization Programme is being
implemented on a priortiy basis. The Government of India initiated the expanded Programme on
Immunisation (EPI) in 1978 with the objective of reducing morbidity, mortality and disabilities
among children from six diseases.
The universal Immunisation Programme (UIP) was introduced in 1985-86 with the objective of
covering at least 85 percent of all infants against six vaccine prevalent able diseases by 1990.
This scheme was been introduced in every district of the country. The standard immunisation
schedule developed for the child immunization programme specifies the age at which each
vaccine should be administrated and the number of doses to be given. Routine vaccinations
received by infants and children are usually recorded on a vaccination card that is issued for the
child.
7.2 Vaccination coverage
This section provides the coverage details of different vaccinations including Polio „0‟, BCG, Polio
„1‟, „2‟ and „3‟, Measles and Vitamin A and whether or not coverage varies across districts, by sex
of the child, by location of the PSU, by the child‟s birth order or even by the education of the
mother. For this analysis, we had taken children who were 12-23 months of age and the evidence
is entirely through service records, i.e. Immunization card available with the household
concerned.
Table 7.1: % of households having vaccination cards on the day of survey, NIPI-08

% of Vaccination card N % N % N % N % N % N % N % N % N %
at the time of survey
Yes (card seen) 488 57.1 254 69.2 554 55.1 134 60.6 590 58.4 131 59.5 1,632 56.9 519 64.2 2,151 58.5
Yes (card not seen) 253 29.6 70 19.1 284 28.2 70 31.7 229 22.7 50 22.7 766 26.7 190 23.5 956 26
No card 113 13.3 43 11.7 168 16.7 17 7.7 191 18.9 39 17.8 472 16.4 99 12.3 571 15.5
Total # of children 854 100 367 100 1,006 100 221 100. 1,010 100 220 100. 2,870 100. 808 100 3,678 100
81
Table 7.2: BCG and Polio „0‟ coverage by background variables, NIPI-08
Indicator BCG Polio 0

Districts N % N %
Hoshangabad 303 91 182 54.7
Narsimhapur 285 94.7 171 56.8
Raisen 288 90 216 67.5
Sex of the Child
Boy 460 92.0 307 61.4
Girl 416 91.6 262 57.7
Location of PSU
Rural 666 69.8 432 45.3
Urban 210 22.0 137 14.4
Births order of Child
1 317 92.4 204 59.5
2-3 317 33.2 204 21.4
4-5 420 44.0 268 28.1
6+ 112 11.7 79 8.3
Years of schooling of mother
No schooling 309 90.9 191 56.2
<5 44 93.6 31 66.0
5-7 199 90.0 135 61.1
8-9 197 94.7 125 60.1
10-11 61 93.8 43 66.2
12 & above 66 90.4 44 60.3
First of all, the trend of BCG coverage in the study area

has increased with almost full as compared to DLHS 3 …just last July I was trained for
which was 84.2 % but Polio „0‟ coverage was near about seven days in „Pawarkheda‟
60%. The coverage of Polio „0‟ was highest in Raisen training centre regarding
(68%) but much lower in Hoshangabad (55%) and education to be given to
Narsimhapur (57%). children…we must be told more
about health issues of mother
Coverage of Polio 0 was marginally higher among boys and child…if we are trained
than girls but not significantly slow to conclude in favour regarding immunization then we
of any gender bias in coverage. Polio 0 coverage in rural can do a better job…if we know
areas is a good 31 percentage points more than in urban about the injections, etc., we can
areas. give better service… - Kusumlata
harma, AWW, Village Posera,
The birth order has not had any influence on coverage of Pipariya, Hoshangabad
either vaccines but the education of mother seems to be
definitely influenced by it with coverage of Polio 0 steadily increasing with the number of years of
schooling undergone by the mother.
82
Table 7.3: Polio vaccine coverage by background variables, NIPI-08
Indicator OPV 1 OPV 2 OPV 3

Districts N % N % N %
Hoshangabad 314 94.3 302 90.7 278 83.5
Narsimhapur 278 92.4 262 87.0 240 79.7
Raisen 293 91.6 267 83.4 234 73.1
Sex of the Child
Boy 464 92.8 430 86.0 398 79.6
Girl 421 92.7 401 88.3 354 78.0
Location of PSU
Rural 673 70.5 632 66.2 574 60.2
Urban 212 22.2 199 20.9 178 18.7
Birth Order
1 326 95.0 312 91.0 283 82.5
2-3 427 44.8 400 41.9 363 38.1
4-5 107 87.0 98 79.7 88 71.5
6+ 25 83.3 21 70.0 18 60.0
Years of schooling
None 309 90.9 282 82.9 247 72.6
<5 42 89.4 35 74.5 33 70.2
5-7 206 93.2 196 88.7 181 81.9
8-9 198 95.2 191 91.8 173 83.2
10-11 61 93.8 58 89.2 53 81.5
12 & above 69 94.5 69 94.5 65 89.0
The incidence of Polio 1,2 and 3 having been given to the index child is high and with little
variations across background variables. Relatively speaking, there is a coverage leakage of OPV
3 to the tune of 16.5% in Hoshangabad and around 26.9% in Raisen district.
Table 7.4: DPT vaccine coverage by background variables
DPT 1 DPT 2 DPT3

Districts N % N % N %
Hoshangabad 315 94.6 301 90.4 276 82.9
Narsimhapur 271 90.0 254 84.4 234 77.7
Raisen 284 88.8 255 79.7 228 71.3
Residence
Rural 662 91.7 617 85.5 564 78.1
Urban 208 89.7 193 83.2 174 75
DLHS3 indicates that more than two fifth of children received all three doses of DPT vaccination
in MP while a slightly better doses of DPT were recorded in Narsimhapur (62%) and Raisen
(62.6%). Consequently a slightly higher coverage of DPT vaccination was observed in
Hoshangabad (all three doses of DPT vaccination.) (See table 7.4).
Consequently in NIPI Survey, DTP coverage is also fairly high as compared to DLHS3 but drops
progressively from dose 1 to dose 3. Once again, highest coverage was observed in
Hoshangabad (even DTP 3 coverage was 82%) and lowest was in Raisen district. In fact, dropout
was also observed to be the highest in Raisen (from 88.8% dose 1 to 71.3% dose 3). The rural
urban difference in coverage of DPT was observed to be very less percentage.
83
Table 7.5: Coverage of Measles vaccine and Vitamin A by background variables
Indicator Measles vaccine Measles vaccine not Vitamin A vaccine Vitamin A vaccine
received received received received
Districts N % N % N % N %
Hoshangabad 231 69.4 102 30.6 204 61.3 129 38.7
Narsimhapur 194 64.5 107 35.5 176 58.5 125 41.5
Raisen 167 52.2 153 47.8 155 48.4 165 51.6

Sex of the Child
Boy 307 61.4 193 38.6 276 55.2 224 44.8

Girl 285 62.8 169 37.2 259 57 195 43.0
Location of PSU
Rural 444 46.5 278 38.5 408 42.8 314 43.5

Urban 148 15.5 84 36.2 127 13.3 105 45.3
Births order of Child
1 225 65.6 118 34.4 203 59.2 140 40.8

2-3 284 62.0 174 38.0 254 55.5 204 44.5
4-5 69 56.1 54 43.9 64 52.0 59 48.0
6+ 14 46.7 16 53.3 14 46.7 16 53.3
Years of schooling of mother
Illiterate 179 52.6 161 47.4 167 49.1 173 50.9

<5 26 55.3 21 44.7 25 53.2 22 46.8
5-7 150 67.9 71 32.1 137 62 84 38.0
8-9 132 63.5 76 36.5 120 57.7 88 42.3
10-11 52 80 13 20.0 42 64.6 23 35.4
12 & above 53 72.6 20 27.4 44 60.3 29 39.7
There was less considerable variance in coverage of measles vaccine and Vitamin A, not only
across districts but also across different background characteristics of the mother. For both
measles and Vitamin A, the performance of Raisen district was poor (52.2% measles vaccine
coverage and 48.4% Vitamin A coverage). In comparison, the coverage of both in Hoshangabad
and Narsimhapur were close to 70%.
Incidence of full coverage did not vary significantly with the location of the PSU except for the fact
that coverage of Vitamin A in urban areas was a good 29.3 percentage points lower than rural. It
also did not vary much with the gender of the index child.
Interestingly, the coverage did vary with birth order with mothers for whom this was the first child
tended to be more particular about immunization coverage (66% measles vaccine coverage and
59% Vitamin A coverage) than those for whom this was the fourth child (47% respectively).
However immunisation coverage has tend to increase with more than sixth child after the fourth
child (46.7% and 59.2% respectively). This essentially implies that younger mothers tend to be
more aware of immunization routines and took their child for vaccination more regularly than
those who were older.
Coverage also varied significantly with education of mother with only 53% of the illiterate mothers
th
having children with measles vaccine as against mothers who were educated beyond the 10
standard (over 80% coverage).
84
Table 7.6: Immunization coverage – all basic vaccines
Districts N %
Hoshangabad 208 62.5
Narsimhapur 180 59.8
Raisen 149 46.6
All basic vaccines cover the following:
 BCG …the first thing we do with new born is give her

 DPT 1, 2 and 3 BCG…we tell the mother to give the first milk
 OPV 1, 2 and 3 without fail…I received training in Raisen for
 Measles two days…it was a special training…I was told
more about immunization…I could now
According to NFHS-3, In MP, more than one administer the „injections‟ more properly…we
third (36 percent) of the children of 12-23 now advise to administer the DPT vaccine in
months had full vaccination. In Narsimhapur the thigh…and the measles „injection‟ in hand…
and Raisen nearly two fifth fourth of the - Parveen Bano, ANM, village Bamori Gondai,
children received full immunisation (39 and Gairatganj, Raisen
41 percent respectively) with the
corresponding figure for Hoshangabad
District being 36.2%
Table 7.7: Child Immunisation Coverage in NIPI Districts, MP
MP Hoshangabad Narsimhapur Raisen

Full immunisation 36.2 54 40.5 39.2
BCG 84.2 96.5 88.9 89.8
Polio 3 55.1 73.6 57.3 55.1
DPT 3 47.4 65 55.9 46.5
Measles 57.7 80 62 62.6
Percentage received at least one dose of Vitamin A 39.5 15.2 43 39.5
Source: District Level Household Survey (2007-2008)
A recent DLHS 3 survey indicates that full vaccination of children was at 36.2%. Consequently
trends show full vaccination coverage has increased over the period of years in NIPI districts. The
full immunization coverage varied considerably among the three program districts with
Hoshangabad having the best performance (62.5%) and Raisen having the worst (46.6%).
Incidence of full coverage did not vary significantly with the location of the PSU with rural
coverage being 56.8% and urban, 54.7%. It also did not vary much with the gender of the index
child with the differences between full immunization coverage of a boy and a girl child being in the
entire sample of children who were 12 to 23 months of age.
Interestingly, the coverage did vary with birth order with mothers for whom this was the first child
tended to be more particular about immunization coverage (58.9% coverage) than those for
whom this was the fourth child or more (54.5% to 36.7%). This essentially implies that younger
mothers tended to be more aware of immunization routines and took their child for vaccination
more regularly than those who were older.
Coverage also varied with education of mother with only 48.8% of the illiterate mothers having
th
children fully immunized as against mothers who were educated beyond the 10 standard (65%
coverage respectively).
85
…We have to go to CHC to get vaccines... .we waste lot of time

while commuting... we have asked BMO to provide us one ANM/
vaccine supplier ..we can then manage regular supply of vaccines
–ANM Saroj Verma, village Singanama, Pipariya block (Hoshangabad)
…There should be transport facility for us to supply vaccines…ANM-

Dipika Oza, Polah village, Mandip block ( Raisen)
…More VHSC and more ASHA‟s need to established to improve the

immunisation coverage… ANM-Sujata S. Lansoge, Gautampura
village (Raisen)
Table 7.8: Place of immunisation received

Place of vaccination
N % N % N % N %
In-laws home 7 2.5 12 4.4 24 8.6 43 5.1
Parents home 1 0.4 4 1.5 3 1.1 8 1.0
Other home 2 0.7 2 0.2
Government and Municipal hospital 22 7.7 35 12.9 25 9.0 82 9.8
CHC/Rural hospital 36 12.6 16 5.9 32 11.5 84 10.1
Public Health Centre 13 4.6 19 7.0 30 10.8 62 7.4
Sub Centre 23 8.1 18 6.6 13 4.7 54 6.5
Govt./ Ayush Hospital/Clinic 1 0.4 1 0.1
Private hospital/clinic 13 4.6 5 1.8 1 0.4 19 2.3
Other 170 59.6 160 59.0 150 53.8 480 57.5
Total 285 100 271 100 279 100 835 100
Table 7.7 shows the place at which most of childhood vaccinations received in programe districts
were other health facilities. About 10% of children were immunized at the government and
municipal hospital. Further, among the children immunized, 10% of them were immunized from
the Community Health Facility or from Rural hospital, 7% from Public health center and 6.5 %
from Sub center. The percentage or children receiving vaccination from the Private hospital/clinic
in the overall program districts is very low.
Table 7.9: Problems faced by mother/community in vaccinating the child
Indicator District
Total Total Total
N % N % N %
No time from daily wage work 71 6 177 14.7 130 11
Distance of Health Facility/ Vaccination Centre 46 3.9 61 5.1 83 7
Irregular presence of health professional 11 0.9 38 3.2 78 6.6
Non- availability of vaccines 8 0.7 17 1.4 32 2.7
Don't Know / Can‟t say 83 7 119 9.9 62 5.2
No Problem Faced 673 56.8 560 46.6 613 51.4
Any other 303 24.7 269 19.1 253 16.1
Total 1,184 100 1,202 100 1,185 100
Multiple responses
Despite less than optimal coverage, the mothers did not perceive to be facing in problem in
getting their child vaccinated. To a small extent, distance to health facility and irregular presence
of health professional was cited as a deterrent in Raisen district.
86
Table 7.10: Dropout rate
Indicator OPV2 – OPV1 OPV3 – OPV2 DPT2 – DPT1 DPT3 – DPT2

% % % %
Hoshangabad -3.6 -7.2 -4.2 -7.5
Narsimhapur -5.4 -7.3 -5.6 -1.5
Raisen -8.2 -10.3 -9.1 -4.4
The incidence of immunization coverage was incumbent upon mobilisation actually effected on
days of „camps‟. It has been observed that ANM being the nodal agency and that she had to
function through help and support garnered from „local‟ service providers. For Raisen, drop out
rate is higher than rest two; one of the major reasons as told by DPM official of Raisen was that
there is an acute shortage of supply of vaccines. The only exception was in Hoshangabad, with
drop out in DPT3-DPT2 was due to illiteracy among the population.
Summary Observations
It was found that for immunization was specialized duty of the ANM to administer the same and
take charge of this sector. There was little intervention of AWW in this sector, yet the fact
remained that almost all major activities were arranged in the Aanganwadi center.
In these programs of
immunization ASHA was … ASHA and AWW are primary health care providers…
not always welcome, since both take each others help…but it was observed that after
the latter was seen as appointment of ASHAs, AWWs and ANMs had been
working on „commercial‟ sidelined…and they think that for the job which was their
temporary basis and not normal duty an additional person is being paid „extra‟
treated to be a proper amount…they think that since ASHA is not “government”
“government” service employee, she will be gone once NRHM is finished… -
provider. ASHA among the DPM, District Raisen
troika of ANM, AWW and
ASHA was the only one without a „place of her own‟ like the Anganwadi center for the AWW and
the sub-center health facility for the ANM.
87
Chapter 8
Status of Health Facilities and Health Management Information
System (HMIS)
8.1 Introduction
The Ministry of Health and family welfare, Government of India is implementing a Maternal and
New born care programme in the country. Under this programme a range of maternal and
newborn care services are provided through a network of government health facilities. The
programme also aims to strengthen health infrastructure in terms of trained staff, equipment and
supplies to enable the facilities to provide4 good quality MNCI services.
The purpose of facility survey, NIPI intervention districts were to understand the status of health
facilities at all the levels.
8.2 Status Of District Hospital (DHs)
In the hierarchical health care system of the Government of India in a district, the district hospital
is the apex body, which provides specialized health care services to people on subsidized costs.
Every district is expected to have a district hospital. The information collected and analyzed in this
section relates to 3 district hospitals of MP.
8.2.1 Physical Infrastructure
Physical infrastructure was comparatively good for the 3 NIPI district. All three have a separate
government building with 24-hour water supply. All the district hospitals have three-phase
electricity connection. The standby facility in the form of generator is available in all hospitals. All
the three district hospitals have functional toilet facility separately for male and female.
All the DH‟s had computer facility but the access to Internet facility was available for only 1 DH‟s
Telephone facility is available in all the district hospital but only 1 DH‟s had telephone facility all
section. All the DHs have at least one vehicle and one ambulance. More than two jeeps and at
least one car was available in all the three DH‟s
8.2.2 Staff in Position
In NIPI intervention good proportion of senior doctors, specialist, GYOB and anesthetist were
found in position, presently all the vacant posts were filled by contractual staff. . It was found a
good proportion of medical superintendent (3), specialist (6), Pediatrician (4) GY/OB (5) and
anesthetist (4) were found in position in all the three DH‟s .
Similarly most the sanctioned posts of various staff, such nurses (132), Auxiliary Nurse
Midwife/PHN (4) for conducting deliveries are filled and available at the time of interview.
8.2.3 Laboratory facility at district hospital
The investigative and laboratory facilities such as blood urea, blood creatinen, pregnancy test,
Elisa for HIV test, VDRL test, ultrasound, fully operational blood bank were found fully available in
all 3 DH’s. Apart from this, only two DH’s had facilities of Sputum, Coomb’s test and X ray while
one DH’s had facilities of Hematology and Urine analysis was found available in all 3 districts.
88
8.2.4 Availability of Beds
In all, there are 7 wards in three DH, number of wards varies between all districts hospital. There
are about 219 beds in 3 hospitals. The maximum numbers of unit have 20 beds. In others
hospitals the number of beds varies between 30 in one and 95 in another hospital. All the
hospitals have separate female and pediatric wards. The occupancy rate of maternity beds was
quite high in past 6-7 month; this may be influence of JSY or increase in awareness level of
general community. On the other hand the occupancy rate of pediatric beds was very low in past
6 months.
8.2.5 Operation Theater
Table A30, shows availability of Elective OT –major emergency OT/Family welfare OT,
Ophthalmology/ ENT OT, Orthopededic OPD was available and working status in all 3 district
hospitals. OT is available for major surgeries and separate Labour rooms for conducting
deliveries.
8.2.6 Neonatal equipments and Nursery services
Data was collected on the ground status about availability of critical child health units and nursery
facility available in the Districts hospitals. Incubator, radiant warmer and emergency resuscitation
kit was available in all the hospitals for newborn care.
8.2.7 Emergency Obstetric Care and MCH facility
All the 3 district hospitals provides 24 hour surgical interventions while only 2 DH‟s have 24 hour
obstetrician /gynecological, anesthetist nurse available for emergency obstetrics services.
All the district hospitals have essential MCH services available for normal and assisted delivery,
other gynecological disorder and treatment for low birth weight children.
All the three District Hospitals have adequate staff and instruments available as per the Indian
public health Standards (IPHS)
8.3 Status Of Community Health Center (CHCs)
The Community Health Centers (CHCs), which constitute the secondary level of health care
designed to provide referral as well as specialist health care to the rural population. These
centers are however fulfilling the tasks entrusted to them only to some extent. Three each CHC
from each districts were survey for the study.
8.3.1 Infrastructure
All the nine CHCs are in the government building with regular supply of water and electricity.
Almost all (8)CHC‟s except for only one CHC had functional toilet facility. While7 separate toilets
were found functional for men and women
89
8.3.2 Staff Position
In the all the CHCs, 7General surgeon, 4Physician, 2GYOB and 28General Medical officer and 3
public health program managers were in position. While another 5 General surgeon, 1 physician,
1 GY/OB and 17 General Medical officer and 1public health program managers were on contract
Similarly staff nurses (43), ANM (43) and midwifes (28) were in position and on contract also.
Post of pharmacist, radiographer and dresser are filled with adequate number of staff. Staff and
ANM are available around the clock, while gynecologist (4) and anesthetist (1) were available on
call in case of emergency.
8.3.3 Trainings
In last five years staff from all the CHCs received training on various topics like NSV, HIV/ AIDS
prevention, new born care and integrated management of neonatal and childhood illness.
8.3.4 Operation Theatre (OT) and Equipment
Tables A 51 to A52 shows the availability of OT and working status of various equipments. IOT is
available in all the 3 hospitals. Except in Narshimhapur district other two hospitals have separate
OT for GYOB. Generator is available in all units for OT and regular fumigation id done regularly in
two hospitals. Weekly sterilization days were display in notice board, near front desk of the
hospital.
As far as the availability of various operation theatre equipments in hospital is concerned, except
instrument for anesthesia all other necessary equipments were found in good condition and well
functional.
8.3.5 MCH services
All the all CHCs have 24 hours obstetrician/gynecological, amethysts, nurses available for
emergency obstetrics services, along with this all the hospitals provide 24 hours surgical
intervention.
All CHCs organized regular ANC. PNC and Child immunization clinics, a part from treatment for
other gynecological disorder and MTP is also available for the women.
Other Functions and services
Out of 9 hospitals 7 provided nutritional services, while other services like school health
programmes, promotion of safe water supply and basic sanitation, HIV/ AIDS control programme,
and regular monitoring by RKS.
Overall Performance
Table 8.2.6 shows that overall performance of the hospital. As large as around 9000 patients
were examined in OPD during last 1 year, maximum number of patients visited in Raisen District
hospital. In all 500 cases were provided medical emergency care in 43 hospitals during last 1
year.
90
All the CHCs provide the “assured service” as per Indian Public Health Standards; the clinical and
paramedical staffs are adequate in number. However except 2 all the CHCs are having sufficient
number of surgical instruments, but essential laboratory instruments were not available in any of
CHCs.
For details of facility survey conducted among CHC in all 3 NIPI districts please refer to tables
A37-A58 given in Annexure tables.
8.4 Status Of Primary Health Centre (PHCs)
The primary health centers have the major responsibility of providing both preventive and curative
health care services in the area. This includes delivery of reproductive child health services, such
as antenatal care and immunization in addition to routine inpatient and out patient services.
Compared to DHs and sub-divisional Hospitals, PHCs are accessible to a larger population.
However, just the availability of PHCs is not sufficient for the effective delivery of these services.
They should also have essential infrastructure, staff, equipment and supplies.
In all the NIPI intervention districts of MP, 17 PHCs were covered under the survey.
8.4.1 Physical Infrastructure/facilities
As seen the table A59, except 1 PHC all the surveyed PHCs have their own buildings, out of 17,
15 PHCs have their own buildings.
12 PHC‟s got regular supply of water for 24 hours while 8 PHC‟s got supply of through own bore
well and for remaining 8 PHC‟s water was provided through pipes and hand pump.
Only 3 PHC‟s got regular supply of electricity while 11 PHC‟s observed regular power cut. It was
also found that 10 PHC‟s had standby facility of generator/invertors available in working condition
13 PHC‟s had toilets facility; out of which 10 PHC‟s had separate toilets for males and females.
Among the PHC‟s most of the units had pit toilets.
8.4.2 Staff position
The post of medical and paramedical staff of various categories and their service training status is
shown in Table 62. It was found that 13 Medical officers position was filled in total 17 PHC‟s.
A slightly better proportion of ANM (11) and staff nurses (6) were in position in all the covered
PHC‟s while 10 additional ANM /staff nurse was found in position in coverage PHC‟s. Most of
them received in–service training during the last 5 years in IUD insertion, MTP and skill birth
attendant. 6 male health workers in all PHCs were found in position at the time of survey.
8.4.3 Operation Theater and Labour room
Operation Theater was available and functional in 13 PHCs, while 5 PHCs had separate well-
equipped Labour room facility. In 4 PHCs fumigation was being done regularly. Separate ANC
clinic, were available in 16 PHCs respectively and in all these PHCs rooms were being utilized for
the purpose these are meant for.
91
8.4.4 Equipment (Drug Kits)
It was found that mostly Kit B drugs was available and functional followed by Kit A Drugs while Kit
C and Kit D drugs was available in 6 PHC‟s each. . Kits for essential obstetric care were supplied
in 7 PHCs respectively. Normal delivery kit and vacuum assisted delivery kit was found in 13 and
4 PHCs respectively. Only 4 Incubator was available in the total PHCs.
The immunization vaccines such as BCG, DTP, OPV measles, DT and TT were available in
sufficient quantity in all the PHCs. These are directly procured from the concerned CHCs by ANM
on the day of immunization.
Prophylactic drugs and other items such as IFA tablets, vitamin A (syrup), ORS packets and
contrimaxazole tablets were available in sufficient quantity in all the 17 PHCs. The supply of
these items was reported to be regular. ANM directly procure those from the concerned CHCs
and distribute them further in their respective areas.
8.4.5 Furniture
Essential furniture like, Almirah and waiting bench was fully available in 17 PHC‟s. Chair, wooden
table and instrument tray was found available in 16 PHC‟s while swab rack in 9 PHC‟s, mattress
in 13 PHC‟s medicine cabinet in 11 PHC‟s and side rail in 3 PHC‟s was found only.
For details of facility survey conducted among PHC in all 3 NIPI districts please refer to tables
A59-A69 given in Annexure tables.
As per IPH standard, all the surveyed PHC‟s does not have sufficient number of human
resources (both clinical and paramedical). The quality and quality of surgical and non-surgical
instruments were not up to the marks.
8.5 Status Of Sub Centre (SCs)
Sub-centers are most peripheral health institutions catering to the health care needs of the rural
population. It is the most peripheral contact point between the Primary Health Care system and
the community. It is manned by one multipurpose worker (male) and one multipurpose worker
(female)/ANM. This section presents the findings of 93 SCs from three districts of MP
8.5.1 Coverage of SCs
Total 93 SCs surveyed for the study, in which 4 SC were in government building, 11 in rented
building and remaining 43 were in rent free panchayat building. Only 51 % of SCs has regular
water and electricity supply.
8.5.2 Staff
All the surveyed SCs have ANM, female health worker and male health workers; most of the
ANMs are serving from 5 to 10 year in particular area. As part of regular activities all the ANMs
give regular visits in the villages for immunization and for ANC and PNC checkups.
It was found that only 30% of ANMs residing in sub center village.
8.5.3 Training
Almost all the Sub center staff has received training on DOTs, Immunization, plus polio,
integrated management of neonatal and childhood illnesses (IMNCI) training and VBDCP.
92
8.5.4 Regular Supply of Contraceptives and Vaccines
Regular supply of essential, medicines, vaccine and contraceptives were observed in almost the
sub centers, it was reported by most of the ANMs that they personally has to visit CHC for
collection of vaccine a day before immunization day.
96 % of ORS for prevention of diarrhea was available in Sub centers, while disposable delivery kit
was available only in 45 % of the sub centers. A separate Labour room was available only in 29%
of the sub centers
Overall Performance of Sub centers as per the IPHS
Since sub centers is most primary unit of health care system and major load of patients approach
sub centers in case of emergency. Absence of health professional in sub centers during odd
hours is a major of concern; around 70% of ANM were not living in sub center village, which leads
delay in referral service. Non-availability and absence of essential medicine and instruments is
also observed in most of the sub centers. None of the SCs were found up to the mark as per
IPHS.
8.6 Health Management Information Systems (HMIS)
Health Management Information Systems enable disaggregated analysis of health situation and
performance of health systems, which enable better monitoring and evaluation and evidence
based planning.
The NRHM provides Rs. 2 lakhs for the State and Rs. 25,000/- per district for district public report
on health. The respective reports on Health are generated based on a standardized format
through outsourcing. State Report and the District Reports for all the districts are prepared on
annual basis.
As per the discussion with state officials, District Data Assistant (DDA) is available at each DPMU
for data collection, entry and submission of required information for district intervention. Every 1st
week of the month information for the previous month is compiled at DPMUs and thereafter in the
2nd week of next month information is sent to the state. The information flows from block to
district. Also additional information is provided from DPM and DDA. The monitoring of information
flow is done at the state level on the basis of monthly Physical & Financial progress report that is
submitted by the district.
To avoid overlapping and ensure better coordination, a MIS cell was planned however it is yet to
implemented and located at Directorate of Health Services, Bhopal.
As per the District Data Assistant of all the NIPI districts, the Health workers maintain registers
such as records on JSY, Dindayal Antyodaya Upchar Yojna, ANC reporting, Birth, Death Format,
MTP, RTI/ STI, immunisation reports, staff position etc. Also, district officials revealed that
currently HMIS have all information on maternal health-such as name, birth background, child
birth- male/female, ANC checkups, delivery verification etc.
The responses of the officials regarding MIS are given below:
93
In a district only 1 computer is available. While out of 15 PHCs only 1 computer is present….
DDA (Hoshangabad)
There is no Software format available…. DDA (Hoshangabad and Narsimhapur)
We require Data entry operators. DDA (NIPI districts)
No website, no MIS is available at the district level…we work on excel only…DDA
(Hoshangabad)
At district level 7 computes with 4 trained personnel is available while out of 20 PHCs, 6 PHCs
have computer with 4 trained personnel ….DDA (Narsimhapur)
CHCs and SCs are running short of computers…. DDA (Raisen and Narsimhapur)
PHCs are not able to send HMIS information on time as they are running short of manpower.
DDA (Raisen)
There is shortage of professional manpower to handle the quality of HMIS data…DDA
(Narsimhapur and Hoshangabad)
Information on Immunisation coverage received is complete but carries duplication of
information from one reporting (RMIS) to another (D&E)…. DDA (Raisen)
Reports are not available for monitoring immunisation coverage…DIO (Narsimhapur)
8.7 Funds Flow in MP
Figure 8.1 Budget allocated and Expenditure for MP

35,000
In INR in Lakhs
30,000
25,000
20,000
15,000
10,000
5,000
Budget Planned Expenditure incurred till Jan 08 % of funds used
Source: * Financial and Physical progress report (2007-2008) , Health Deptt., GoMP
Figure 8.1 indicates that 68 percent of the total funds were utilised in case of mental health while
15% were utilised in case of child health. A maximum of 80 percent fund utilisation was reported
in case of Janani Suraksha Yojana, while only 22 percent of total funds allocated for training were
utilised (Table 8.1)
Table 8.1 Budget Allocated and Expenditure for MP
94
SL. Intervention Budget Planned Expenditure % of funds

No incurred till Jan 08 used
1 RCH 1041162000 463731387 44 %
2 Training 116257000 25903432 22 %
3 Additionalities 2216002000 1811367442 81 %
4 NRHM 1921000000 518492870 26%
5 Immunisation 230650000 55616957 24%
6 Maternal Health 313870000 215464253 69%
7 Child Health 107960000 16327085 15%
8 JSY 1890002000 1520874508 81%
9 Immunisation 230650000 55616957 24%
10 Other 2982589000 836031648 28%
Source: * Financial and Physical progress report (2007-2008) ,Health Deptt., GoMP
Budget Allocated and Utilised for Child Health in NIPI districts
In Hoshangabad district, 26 percent of total budget for 2007-2008 was utilised in case of child
health care.
A total of 95 percent of funds were utilised in case of infrastructure and human resources across
the state. In Hoshangabad, only 6 percent of funds were utilised for infrastructure and human
resource while in Raisen 41 percent funds were utilised.
A total of 22 percent of funds were utilised in training across the state. For Hoshangabad only 5
percent of funds for training were utilised, while in Raisen district, 15 percent of funds were
utilised.
About 78 percent of the allocated funds were utilised in maternal health including JSY.
Approximately 20 percent of total budget for maternal health and JSY in Hoshangabad was
utilised while in Raisen only 23 percent of total funds for maternal health and JSY were utilised.
Untied Fund
National Rural Health Mission proposes to provide to each Sub Health Center a sum of Rs.
10,000/- as an untied fund to facilitate meeting urgent yet discreet activities that need relatively
small sums of money. For this purpose funds is kept in a joint bank account of ANM and
Sarpanch.
This fund is utilized and spent on the activities approved by the Village Health Committee and
administered by the Auxiliary Nurse Midwife. The state of Madhya Pradesh has 8835 Sub Health
Centres. A sum of Rs.10,000/- is allocated per Sub Health Centre in the district plan of each
district.
In NIPI districts, CMHO of the district transfers this fund to the ANMs with the instructions that this
fund is kept in a joint account of ANM and Sarpanch and is administered and utilized by the ANM
for the activities approved by the Village Health Committee. The guidelines include the directions
for keeping the record and replenishment of this fund.
95
Annexure
A1: Household possession – NIPI Districts
District MP
Hoshangabad Narsimhapur Hoshangabad Narsimhapur
% % % % % % % % % % % %
Household Goods
Mattress Yes 69.2 73.8 70.6 66.9 72.6 67.9 66.0 84.7 69.3 67.3 76.4 69.3
No 30.8 26.2 29.4 33.1 27.4 32.1 34.0 15.3 30.7 32.7 23.6 30.7
Mosquito net Yes 42.1 48.2 44.0 32.2 42.8 34.0 50.6 66.0 53.4 41.6 51.6 43.8
No 57.9 51.8 56.0 67.8 57.2 66.0 49.4 34.0 46.6 58.4 48.4 56.2
A cot/bed Yes 96.3 91.2 94.8 90.7 82.8 89.3 90.7 93.0 91.1 92.4 89.4 91.7
No 3.7 8.8 5.2 9.3 17.2 10.7 9.3 7.0 8.9 7.6 10.6 8.3
Chair Yes 55.7 72.2 60.7 49.1 65.1 51.9 51.3 69.3 54.5 51.8 69.5 55.7
No 44.3 27.8 39.3 50.9 34.9 48.1 48.7 30.7 45.5 48.2 30.5 44.3
Table Yes 31.5 45.7 35.8 18.3 33.0 20.9 29.9 47.0 32.9 26.3 42.6 29.9
No 68.5 54.3 64.2 81.7 67.0 79.1 70.1 53.0 67.1 73.7 57.4 70.1
Pressure cooker Yes 36.8 66.4 45.7 16.3 52.6 22.7 29.9 59.5 35.2 27.1 60.8 34.5
No 63.2 33.6 54.3 83.7 47.4 77.3 70.1 40.5 64.8 72.9 39.2 65.5
Radio or Transistor Yes 13.8 16.3 14.5 7.8 15.3 9.1 20.2 37.2 23.2 13.9 21.7 15.6
No 86.2 83.7 85.5 92.2 84.7 90.9 79.8 62.8 76.8 86.1 78.3 84.4
Watch or clock Yes 59.2 78.8 65.1 37.0 56.3 40.4 52.7 67.9 55.4 49.0 69.7 53.6
No 40.8 21.2 34.9 63.0 43.7 59.6 47.3 32.1 44.6 51.0 30.3 46.4
Sewing Machine Yes 17.4 30.0 21.2 9.8 25.6 12.6 17.7 30.2 19.9 14.8 28.9 17.9
No 82.6 70.0 78.8 90.2 74.4 87.4 82.3 69.8 80.1 85.2 71.1 82.1
Electricity Yes 80.4 90.6 83.5 85.6 88.8 86.1 83.0 86.5 83.7 83.1 89.0 84.4
No 19.6 9.4 16.5 14.4 11.2 13.9 17.0 13.5 16.3 16.9 11.0 15.6
An Electric fan Yes 50.8 78.5 59.2 38.7 72.6 44.7 47.6 64.7 50.6 45.4 73.1 51.5
No 49.2 21.5 40.8 61.3 27.4 55.3 52.4 35.3 49.4 54.6 26.9 48.5
Television Yes 37.3 65.6 45.8 30.0 56.3 34.6 36.6 59.1 40.6 34.4 61.3 40.3
No 62.7 34.4 54.2 70.0 43.7 65.4 63.4 40.9 59.4 65.6 38.7 59.7
Refrigerator Yes 6.3 18.2 9.9 2.6 12.6 4.3 4.4 14.9 6.3 4.3 15.8 6.8
No 93.7 81.8 90.1 97.4 87.4 95.7 95.6 85.1 93.7 95.7 84.2 93.2
Computer Yes 1.7 5.0 2.7 0.5 5.6 1.4 2.4 7.0 3.2 1.5 5.7 2.4
No 98.3 95.0 97.3 99.5 94.4 98.6 97.6 93.0 96.8 98.5 94.3 97.6
Mobile phone Yes 29.0 42.1 33.0 13.6 28.8 16.3 24.0 38.1 26.6 21.8 37.5 25.3
No 71.0 57.9 67.0 86.4 71.2 83.7 76.0 61.9 73.4 78.2 62.5 74.7
Any Other type of telephone Yes 3.5 3.9 3.6 4.3 7.9 4.9 3.8 8.4 4.6 3.9 6.2 4.4
No 96.5 96.1 96.4 95.7 92.1 95.1 96.2 91.6 95.4 96.1 93.8 95.6
Water pump Yes 14.6 7.7 12.6 13.3 4.2 11.7 8.0 7.0 7.8 11.9 6.6 10.7
No 85.4 92.3 87.4 86.7 95.8 88.3 92.0 93.0 92.2 88.1 93.4 89.3
Thresher Yes 2.9 1.1 2.3 5.2 0.9 4.4 4.6 1.9 4.1 4.3 1.3 3.6
No 97.1 98.9 97.7 94.8 99.1 95.6 95.4 98.1 95.9 95.7 98.7 96.4
Tractor Yes 10.5 5.5 9.0 5.8 4.7 5.6 11.1 7.0 10.4 9.0 5.7 8.3
No 89.5 94.5 91.0 94.2 95.3 94.4 88.9 93.0 89.6 91.0 94.3 91.7
Bicycle Yes 39.0 46.6 41.3 34.2 34.9 34.3 33.5 36.3 34.0 35.4 40.6 36.5
No 61.0 53.4 58.7 65.8 65.1 65.7 66.5 63.7 66.0 64.6 59.4 63.5
An animal drawn cart Yes 15.6 2.2 11.6 13.7 1.9 11.6 13.4 7.9 12.4 14.2 3.7 11.9
No 84.4 97.8 88.4 86.3 98.1 88.4 86.6 92.1 87.6 85.8 96.3 88.1
A car/Jeep Yes 2.0 1.9 2.0 0.5 1.9 0.7 2.8 2.8 2.8 1.8 2.1 1.8
No 98.0 98.1 98.0 99.5 98.1 99.3 97.2 97.2 97.2 98.2 97.9 98.2
Two wheeler/ motorbike Yes 25.4 31.1 27.1 13.2 21.4 14.7 15.3 22.8 16.6 17.5 26.2 19.4
No 74.6 68.9 72.9 86.8 78.6 85.3 84.7 77.2 83.4 82.5 73.8 80.6
Bus/Truck Yes 0.6 0.4 0.5 0.1 0.6 0.5 0.6 0.4 0.3 0.4
No 99.4 100 99.6 100 99.5 99.9 99.4 99.5 99.4 99.6 99.7 99.6
Total # of HH 840 363 1203 1004 215 1219 990 215 1205 2834 793 3627
96
A2 Type of health schemes- NIPI districts
District
MP
Type of health scheme or health
insurance
% % % % % % % % % % % %
Employees State Insurance 20.7 20.5 20.6 5.2 27.6 12.6 3.3 8.3 5.6 12.8 19.6 15.2
Scheme (ESIS)
Central Government Health Scheme 5.4 25.0 11.8 3.4 10.3 5.7 3.9 14.4 7.6
(CGHS)
Community Health Insurance 2.2 2.3 2.2 1.7 3.4 2.3 3.3 16.7 9.3 2.2 6.2 3.6
Programme
Other Health Insurance Through 9.8 6.8 8.8 3.4 1.1 13.3 7.4 7.2 4.1 6.1
Employer
Other Privately Purchased 14.1 4.5 11.0 6.9 20.7 11.5 26.7 25.0 25.9 13.9 14.4 14.1
Commercial
Health Insurance 25.0 9.1 19.9 24.1 13.8 20.7 23.3 37.5 29.6 24.4 17.5 22.0
Other 22.8 31.8 25.7 60.3 24.1 48.3 30.0 16.7 24.1 36.1 25.8 32.5
Total number of HH 92 44 136 58 29 87 30 24 54 180 97 277
97
A3 Education Attainments vs. age of respondent
NIPI state wise education

Rural
Total
15-18 19-21 22-25 26-30 31-40 41-49
Years of schooling N % N % N % N % N % N % N %
No Education 35 44.9 278 39.5 518 42.8 321 52.3 130 73.0 8 80.0 1,290 46.2
<5 2 2.6 35 5.0 54 4.5 38 6.2 9 5.1 138 4.9
5-7 19 24.4 179 25.5 264 21.8 108 17.6 22 12.4 1 10.0 593 21.2
8-9 18 23.1 159 22.6 244 20.2 83 13.5 6 3.4 1 10.0 511 18.3
10-11 3 3.8 43 6.1 78 6.5 27 4.4 3 1.7 154 5.5
12 & Above 1 1.3 9 1.3 51 4.2 37 6.0 8 4.5 106 3.8
Total 78 100 703 100 1,209 100 614 100 178 100 10 100 2,792 100
Urban
Total
15-18 19-21 22-25 26-30 31-40 41-49
No Education 1 11.1 26 17.7 88 24.2 44 24.7 26 32.5 2 100 187 24.0
<5 8 5.4 12 3.3 10 5.6 2 2.5 32 4.1
5-7 2 22.2 47 32.0 65 17.9 29 16.3 14 17.5 157 20.2
8-9 4 44.4 43 29.3 92 25.3 29 16.3 8 10.0 176 22.6
10-11 1 11.1 17 11.6 50 13.8 17 9.6 6 7.5 91 11.7
12 & Above 1 11.1 6 4.1 56 15.4 49 27.5 24 30.0 136 17.5
Total 9 100 147 100 363 100 178 100 80 100 2 100 779 100
Total
Total
15-18 19-21 22-25 26-30 31-40 41-49
No Education 36 41.4 304 35.8 606 38.5 365 46.1 156 60.5 10 83.3 1,477 41.4
<5 2 2.3 43 5.1 66 4.2 48 6.1 11 4.3 170 4.8
5-7 21 24.1 226 26.6 329 20.9 137 17.3 36 14.0 1 8.3 750 21.0
8-9 22 25.3 202 23.8 336 21.4 112 14.1 14 5.4 1 8.3 687 19.2
10-11 4 4.6 60 7.1 128 8.1 44 5.6 9 3.5 245 6.9
12 & Above 2 2.3 15 1.8 107 6.8 86 10.9 32 12.4 242 6.8
Total 87 100 850 100 1,572 100 792 100 258 100 12 100 3,571 100
98
A4 Frequency of reading a newspaper or magazine vs. key background variables.
Almost Every Day At Least Once Less Than Not At All Total
A Week Once A Week
N % N % N % N % N %
15-18 2 1.8 46 20.4 13 4.3 36 2.5 51 2.4
19-21 17 15.5 106 47.1 66 21.9 417 28.6 546 26.1
22-25 51 46.4 58 25.8 144 47.7 665 45.6 966 46.1
26-30 28 25.5 14 6.2 67 22.2 274 18.8 427 20.4
31-40 12 10.9 1 0.4 12 4.0 64 4.4 102 4.9
41-49 1 0.1 2 0.1
Total 110 100 225 100 302 100 1,457 100 2,094 100
Education of the Respondent
No Education
<5 2 1.8 9 4.0 13 4.3 146 10.0 170 8.1
5-7 6 5.5 46 20.4 67 22.2 631 43.3 750 35.8
8-9 17 15.5 69 30.7 123 40.7 478 32.8 687 32.8
10-11 23 20.9 41 18.2 57 18.9 124 8.5 245 11.7
12 & Above 62 56.4 60 26.7 42 13.9 78 5.4 242 11.6
Total 110 100 225 100 302 100 1,457 100 2,094 100
A5 Frequency of listening to the radio vs. key background variables
Almost Every Day At Least Once Less Than Not At All Total
A Week Once A Week
N % N % N % N % N %
15-18 3 1.9 4 3.8 4 1.6 76 2.5 87 2.4
19-21 43 26.9 22 21.0 51 20.7 734 24.0 850 23.8
22-25 61 38.1 51 48.6 118 48.0 1342 43.9 1572 44.0
26-30 42 26.3 24 22.9 57 23.2 669 21.9 792 22.2
31-40 11 6.9 4 3.8 16 6.5 227 7.4 258 7.2
41-49 12 0.4 12 0.3
Total 160 100 105 100 246 100 3060 100 3571 100
No Education 20 12.5 9 8.6 62 25.2 1386 45.3 1477 41.4
<5 9 5.6 6 5.7 15 6.1 140 4.6 170 4.8
5-7 32 20.0 19 18.1 54 22.0 645 21.1 750 21.0
8-9 51 31.9 33 31.4 55 22.4 548 17.9 687 19.2
10-11 23 14.4 16 15.2 30 12.2 176 5.8 245 6.9
12 & Above 25 15.6 22 21.0 30 12.2 165 5.4 242 6.8
Total 160 100 105 100 246 100 3060 100 3571 100
99
A6 Frequency of watching television vs. key background variables
Almost Every At Least Once A Less Than Once Not At All Total
Day Week A Week
N % N % N % N % N %
15-18 22 2.1 4 1.6 25 3.2 36 2.4 87 2.4
19-21 255 24.1 52 20.6 203 26.1 340 23.0 850 23.8
22-25 494 46.6 120 47.4 322 41.4 636 43.0 1572 44.0
26-30 225 21.2 59 23.3 165 21.2 343 23.2 792 22.2
31-40 64 6.0 16 6.3 62 8.0 116 7.8 258 7.2
41-49 2 0.8 1 0.1 9 0.6 12 0.3
Total 1060 100 253 100 778 100 1480 100 3571 100
No 146 13.8 68 26.9 348 44.7 915 61.8 1477 41.4
Education
<5 54 5.1 26 10.3 37 4.8 53 3.6 170 4.8
5-7 247 23.3 65 25.7 175 22.5 263 17.8 750 21.0
8-9 295 27.8 54 21.3 145 18.6 193 13.0 687 19.2
10-11 143 13.5 17 6.7 49 6.3 36 2.4 245 6.9
12 & Above 175 16.5 23 9.1 24 3.1 20 1.4 242 6.8
Total 1060 100 253 100 778 100 1480 100 3571 100
Wealth Index
Lowest 99 9.3 70 27.7 414 53.2 1147 77.5 1730 48.4
Second 135 12.7 42 16.6 133 17.1 195 13.2 505 14.1
Middle 180 17.0 51 20.2 116 14.9 91 6.1 438 12.3
Fourth 263 24.8 48 19.0 74 9.5 39 2.6 424 11.9
Highest 383 36.1 42 16.6 41 5.3 8 0.5 474 13.3
Total 1060 100 253 100 778 100 1480 100 3571 100
A7 Employment Status
District
Total
Do you earn something Do you earn something Do you earn something Do you earn something
Yes No Yes No Yes No Yes No Total
N % N % N % N % N % N % N % N % N %
Age Group
15-18 1 5.0 19 95.0 4 21.1 15 78.9 12 25.0 36 75.0 17 19.5 70 80.5 87 100
19-21 40 14.9 229 85.1 51 16.3 261 83.7 62 23.0 207 77.0 153 18.0 697 82.0 850 100
22-25 93 17.7 431 82.3 73 12.6 508 87.4 87 18.6 380 81.4 253 16.1 1319 83.9 1572 100
26-30 64 23.1 213 76.9 51 23.0 171 77.0 80 27.3 213 72.7 195 24.6 597 75.4 792 100
31-40 30 32.3 63 67.7 15 23.1 50 76.9 38 38.0 62 62.0 83 32.2 175 67.8 258 100
41-49 1 100 1 33.3 2 66.7 4 50.0 4 50.0 5 41.7 7 58.3 12 100
No education 140 31.0 311 69.0 114 21.3 420 78.7 170 34.6 322 65.4 424 28.7 1053 71.3 1477 100
Below 5 9 13.8 56 86.2 7 15.2 39 84.8 14 23.7 45 76.3 30 17.6 140 82.4 170 100
5-7 37 15.2 206 84.8 33 13.9 205 86.1 55 20.4 214 79.6 125 16.7 625 83.3 750 100
8-9 20 9.2 198 90.8 29 12.2 209 87.8 31 13.4 200 86.6 80 11.6 607 88.4 687 100
10-11 8 8.2 90 91.8 3 3.8 77 96.3 5 7.5 62 92.5 16 6.5 229 93.5 245 100
12 & above 14 12.8 95 87.2 9 13.6 57 86.4 8 11.9 59 88.1 31 12.8 211 87.2 242 100
Rural 196 23.7 632 76.3 171 17.3 819 82.7 262 26.9 712 73.1 629 22.5 2163 77.5 2792 100
Urban 32 9.0 324 91.0 24 11.3 188 88.7 21 10.0 190 90.0 77 9.9 702 90.1 779 100
100
A8 Children ever born vs. age of mother
District
Hoshangabad
Number of Children Ever Born
1 2 3 4 5 6 7 8 9 10+
Age Group N % N % N % N % N % N % N % N % N % N %
15-18 13 65 6 30 1 5
19-21 170 63.2 77 28.6 18 6.7 2 0.7 2 0.7
22-25 135 25.8 204 38.9 133 25.4 36 6.9 13 2.5 2 0.4 1 0.2
26-30 30 10.8 62 22.4 70 25.3 65 23.5 40 14.4 9 3.2 1 0.4
31-40 4 4.3 16 17.2 11 11.8 23 24.7 17 18.3 9 9.7 7 7.5 3 3.2 2 2.2 1 1.1
41-49 1 100
Total 352 365 233 126 72 21 9 3 2 1 1184
Narsimhapur
1 2 3 4 5 6 7 8 9 10+
N % N % N % N % N % N % N % N % N % N %
15-18 16 84.2 3 15.8
19-21 211 67.6 79 25.3 19 6.1 2 0.6 1 0.3
22-25 141 24.3 282 48.5 11319.4 33 5.7 10 1.7 2 0.3
26-30 22 9.9 54 24.3 5625.2 53 23.9 24 10.8 10 4.5 2 0.9 1 0.5
31-40 4 6.2 11 16.9 1421.5 11 16.9 9 13.8 9 13.8 2 3.1 4 6.2 1 1.5
41-49 1 33.3 1 33.3 1 33.3
Total 394 429 202 100 43 21 4 6 1 1 1201
Raisen
1 2 3 4 5 6 8 7 9 10+
N % N % N % N % N % N %N N% % N % N %
15-18 35 72.9 13 27.1
19-21 131 48.7 98 36.4 31 11.5 8 3.0 1 0.4
22-25 115 24.6 164 35.1 120 25.7 54 11.6 9 1.9 3 0.6 2 0.4
26-30 10 3.4 61 20.8 80 27.3 74 25.3 49 16.7 12 4.1 2 0.7 2 0.7 1 0.3 2 0.7
31-40 6 6.0 7 7.0 5 5.0 17 17.0 18 18.0 19 19.0 12 12.0 7 7.0 5 5.0 4 4.0
41-49 1 12.5 1 12.5 3 37.5 1 12.5 2 25.0
Total 297 343 236 154 77 35 19 10 6 8 1185
101
A9 Treatment seeking behaviour
Give Ors Salt And Continue Continue Give Any Other Do Not
Sugar Normal Breastfeeding Plenty Of (Specify) Know Total
Solution Food Fluids
N % N % N % N % N % N % N % N %
15-18 1 0.2 6 1.4 3 0.7 2 0.5 10 2
19-21 27 6.5 5 1.2 6 1.4 24 5.8 3 0.7 33 8.0 16 3.9 102 25
22-25 42 10.1 9 2.2 10 2.4 38 9.2 2 0.5 49 11.8 40 9.6 167 40
26-30 31 7.5 2 0.5 4 1.0 23 5.5 2 0.5 36 8.7 24 5.8 111 27
31-40 4 1.0 2 0.5 2 0.5 10 2.4 6 1.4 23 6
41-49 2 0.5 1 0.2 1 0.2 2 0
Total 107 25.8 19 4.6 20 4.8 93 22.4 7 1.7 132 31.8 88 21.2 415 100
No Education 36 8.7 11 2.7 11 2.7 34 8.2 2 0.5 57 13.7 39 9.4 172 41
<5 5 1.2 7 1.7 4 1.0 8 1.9 22 5
5-7 27 6.5 1 0.2 2 0.5 15 3.6 5 1.2 37 8.9 22 5.3 96 23
8-9 19 4.6 6 1.4 5 1.2 21 5.1 25 6.0 12 2.9 79 19
10-11 17 4.1 1 0.2 2 0.5 11 2.7 5 1.2 3 0.7 32 8
12 & Above 3 0.7 5 1.2 4 1.0 4 1.0 14 3
Total 107 25.8 19 4.6 20 4.8 93 22.4 7 1.7 132 31.8 88 21.2 415 100
Number of Living Children
1-2 72 17.3 12 2.9 13 3.1 64 15.4 6 1.4 76 18.3 46 11.1 258 62
3-4 31 7.5 5 1.2 6 1.4 24 5.8 1 0.2 45 10.8 32 7.7 126 30
5+ 4 1.0 2 0.5 1 0.2 5 1.2 11 2.7 10 2.4 31 7
Total 107 25.8 19 4.6 20 4.8 93 22.4 7 1.7 132 31.8 88 21.2 415 100
Locality
Rural 82 19.8 16 3.9 17 4.1 71 17.1 7 1.7 111 26.7 75 18.1 340 82
Urban 25 6.0 3 0.7 3 0.7 22 5.3 21 5.1 13 3.1 75 18
Total 107 25.8 19 4.6 20 4.8 93 22.4 7 1.7 132 31.8 88 21.2 415 100
Wealth Index
Lowest 51 12.3 7 1.7 10 2.4 44 10.6 4 1.0 74 17.8 47 11.3 217 52
Second 15 3.6 4 1.0 5 1.2 17 4.1 16 3.9 14 3.4 59 14
Middle 15 3.6 3 0.7 9 2.2 1 0.2 19 4.6 6 1.4 47 11
Fourth 10 2.4 5 1.2 15 3.6 1 0.2 13 3.1 13 3.1 49 12
Highest 16 3.9 3 0.7 2 0.5 8 1.9 1 0.2 10 2.4 8 1.9 43 10
Total 107 25.8 19 4.6 20 4.8 93 22.4 7 1.7 132 31.8 88 21.2 415 100
102
A10 Diarrhea practices

N % N % N % N % N % N % N % N % N %
Continued Breastfeeding/other feeding when child had diarrhoea
Yes 74 86 26 87 28 70 10 77 91 71 9 64 193 76 45 79 238 55
No 11 13 4 13 9 23 3 23 36 28 5 36 56 22 12 21 68 100
NA 1 1 3 8 1 1 5 2 5 65
Total 86 100 30 100 40 100 13 100 128 100 14 100 254 100 57 100 311 8
Liquids given to drink during diarrhoera
Much less 15 17 2 7 5 13 2 15 43 33.6 4 28.6 63 24.8 8 14.0 71 7.1
Some what less 45 52 17 57 19 48 7 54 45 35.2 5 35.7 109 42.9 29 50.9 138 29.0
About the same 22 26 33 12 30 4 31 30 23.4 64 25.2 14 24.6 78 2.8
More 1 0.8 1 7.1 1 0.4 1 1.8 2 28.7
Nothing to eat 3 3 1 3 4 10 8 6.3 3 21.4 15 5.9 4 7.0 19 33.7
Total 1 1 1 0.8 1 7.1 2 0.8 1 1.8 3 16.0
Food given to eat during diarrhoea
Much less 8 9 3 10 4 10 37 28.9 4 28.6 49 19.3 7 12.3 56 100
Some what less 49 57 13 43 18 45 8 62 49 38.3 5 35.7 116 45.7 26 45.6 142 12.5
About the same 22 26 12 40 8 20 3 23 27 21.1 1 7.1 57 22.4 16 28.1 73 31.7
More 2 5 2 0.8 2 51.5
Nothing to eat 5 6 2 7 8 20 2 15 15 11.7 2 14.3 28 11.0 6 10.5 34 2.0
Don‟t know 2 2 2 14.3 2 0.8 2 3.5 4 2.3
Total 86 100 30 100 40 100 13 100 128 100 14 100 254 100 57 100 311 100
Mothers given advice to give ORS during diarrhoea
Yes 35 41 15 50 18 45 8 62 66 51.6 9 64.3 119 46.9 32 56.1 151 5.3
No 51 59 15 50 22 55 5 38 62 48.4 5 35.7 135 53.1 25 43.9 160 0.7
Total 86 100 30 100 40 100 13 100 128 100 14 100 254 100 57 100 311 100
Personnel adviced for ORS
Government Doctor 4 11 3 20 6 33 7 10.6 2 22.2 17 14.3 5 15.6 22 54.2
Private Doctor 14 40 7 47 4 22 6 75 35 53.0 5 55.6 53 44.5 18 56.3 71 2.3
ANM/ASHA/LHV 6 17 3 20 6 33 1 13 11 16.7 1 11.1 23 19.3 5 15.6 28 0.3
Friends/Relatives/ Family Members 2 6 1 7 1 6 1 13 1 1.5 1 11.1 4 3.4 3 9.4 7 0.2
Others 2 6 3 4.5 5 4.2 5 0.8
7 20 1 7 1 6 9 13.6 17 14.3 1 3.1 18 0.5
Total 35 100 15 100 18 100 8 100 66 100 9 100 119 100 32 100 151 33.9
Place of getting ORS
ASHA 1 3 1 6 2 3.0 4 3.4 4 7.8
ANM 2 6 1 7 4 22 1 13 2 3.0 8 6.7 2 6.3 10 100
Government/ Municipal Hospital 1 3 2 13 1 6 5 7.6 1 11.1 7 5.9 3 9.4 10 17.9
CHC/Rural hospital 4 11 1 13 2 3.0 1 11.1 6 5.0 2 6.3 8 80.7
PHC 2 6 4 22 3 4.5 1 11.1 9 7.6 1 3.1 10 1.3
Sub Center 2 11 2 3.0 4 3.4 4 100
GOVT. AYUSH 1 1.5 1 0.8 1 25.4
Private AYUSH 1 1.5 1 0.8 1 44.7
Private hospital/clinic 12 34 4 27 2 11 2 25 13 19.7 3 33.3 27 22.7 9 28.1 36 16.9
Medical/Chemist shop 6 17 6 40 3 17 4 50 24 36.4 2 22.2 33 27.7 12 37.5 45 1.2
Other shops 7 20 2 13 1 6 11 16.7 1 11.1 19 16.0 3 9.4 22 1.0
Total 35 100 15 100 18 100 8 100 66 100 9 100 119 100 32 100 151 10.0
103
A11 Quantity of food and drinks taken while having fever
District
State Total
N % N % N % N % N % N % N % N % N %
Quantity of drink giving during the illness
Much Less 23 17.0 4 6.9 30 28.3 5 17.2 83 37.1 13 26.0 136 29.2 22 16.1 158 12.2
Somewhat Less 55 40.7 24 41.4 46 43.4 14 48.3 97 43.3 29 58.0 198 42.6 67 48.9 265 100
About The Same 52 38.5 19 32.8 22 20.8 9 31.0 29 12.9 5 10.0 103 22.2 33 24.1 136 100
More 5 8.6 1 0.9 1 0.4 2 0.4 5 3.6 7 15.4
Nothing To Drink 3 2.2 4 6.9 7 6.6 1 3.4 14 6.3 3 6.0 24 5.2 8 5.8 32 100
Don‟t Know 2 1.5 2 3.4 2 0.4 2 1.5 4 0.7
Total 135 100 58 100 106 100 29 100 224 100 50 100 465 100 137 100 602 100
Quantity of food given during the illness
Much Less 25 18.5 7 12.1 17 16.0 5 17.2 90 40.2 9 18.0 132 28.4 21 15.3 153 0.7
Somewhat Less 69 51.1 24 41.4 56 52.8 15 51.7 75 33.5 30 60.0 200 43.0 69 50.4 269 0.7
About The Same 34 25.2 20 34.5 17 16.0 7 24.1 20 8.9 4 8.0 71 15.3 31 22.6 102 23.8
More 1 0.7 3 5.2 1 0.9 1 3.4 1 2.0 2 0.4 5 3.6 7 29.8
Stopped Food 4 3.8 2 0.9 6 1.3 6 14.6
Never Gave Food 4 3.0 3 5.2 10 9.4 1 3.4 36 16.1 6 12.0 50 10.8 10 7.3 60 100
Don‟t Know 2 1.5 1 1.7 1 0.9 1 0.4 4 0.9 1 0.7 5 0.8
Total 135 100 58 100 106 100 29 100 224 100 50 100 465 100 137 100 602 100
A12 Advice received from sources & duration of treatment for illness
District
State Total
Advice or treatment N % N % N % N % N % N % N % N % N %
Same Day 15 13.5 10 19.2 16 27.1 12 60.0 31 16.8 9 24.3 62 17.5 31.0 28.4 93.0 20.0
2 days ago 90 81.1 38 73.1 31 52.5 8 40.0 127 68.6 25 67.6 248 69.9 71.0 65.1 319.0 68.8
3 - 4 days ago 5 4.5 3 5.8 10 16.9 16 8.6 3 8.1 31 8.7 6.0 5.5 37.0 8.0
5 - 6 days ago 1 1.9 4 2.2 4 1.1 1.0 0.9 5.0 1.1
Week or more than a 1 0.9 2 3.4 7 3.8 10 2.8 10.0 2.2
week ago
Total 111 100 52 100 59 100 20 100 185 100 37 100 355 100 109.0 100 464.0 100
Advised received from sources during illness
Government/ 4 3.6 7 13.5 2 3.4 3 15.0 6 3.2 3 8.1 12 3.4 13.0 11.9 25.0 5.4
Municipal Hospital
Government 1 0.9 1 1.7 4 2.2 6 1.7 6.0 1.3
Dispensary
UHC/UHP/UFWC 1 0.9 1 1.7 2 0.6 2.0 0.4
CHC/ Rural Hospital 16 14.4 3 5.8 6 10.2 1 5.0 20 10.8 4 10.8 42 11.8 8.0 7.3 50.0 10.8
UMP/RMP 3 2.7 2 1.1 5 1.4 5.0 1.1
PHC 8 7.2 1 1.9 4 6.8 10 5.4 4 10.8 22 6.2 5.0 4.6 27.0 5.8
Sub Center 1 0.9 1 1.7 3 1.6 5 1.4 5.0 1.1
Private Ayush 2 1.8 4 7.7 1 1.7 1 5.0 9 4.9 3 8.1 12 3.4 8.0 7.3 20.0 4.3
Hospital/Clinic
Private Hospital/ 71 64.0 36 69.2 41 69.5 15 75.0 121 65.4 22 59.5 233 65.6 73.0 67.0 306.0 65.9
Clinic
Home 1 0.9 2 1.1 3 0.8 3.0 0.6
Other 3 2.7 1 1.9 2 3.4 8 4.3 1 2.7 13 3.7 2.0 1.8 15.0 3.2
Total 111 100 52 100 59 100 20 100 185 100 37 100 355 100 109.0 100 464.0 100
A13 Child having health problem during illness
104
At the time of illness, child having a problem in the chest or a blocked or runny nose
Chest Only 17 12.6 4 6.9 15 14.2 2 6.9 28 12.5 9 18.0 60 12.9 15.0 10.9 75.0 12.5
Nose Only 57 42.2 25 43.1 35 33.0 9 31.0 49 21.9 16 32.0 141 30.3 50.0 36.5 191.0 31.7
Both 58 43.0 23 39.7 53 50.0 14 48.3 140 62.5 22 44.0 251 54.0 59.0 43.1 310.0 51.5
Don‟t Know 3 2.2 4 6.9 1 0.9 1 3.4 3 6.0 4 0.9 8.0 5.8 12.0 2.0
Other 2 3.4 2 1.9 3 10.3 7 3.1 9 1.9 5.0 3.6 14.0 2.3
Total 135 100 58 100 106 100 29 100 224 100 50 100 465 100 137.0 100 602 100
A14 Problems faced during availing treatment for illness

N % N % N % N % N % N % N % N % N %
Any problems faced during availing treatment
Doctor came late 4 0.5 4 1.1 9 0.9 4 1.9 20 2.1 6 2.8 33 1.2 14 1.8 47 1.3
Long Waiting time 13 1.6 18 5.1 15 1.5 4 1.9 33 3.4 7 3.3 61 2.2 29 3.7 90 2.5
Long Que of patients 5 0.6 7 2.0 6 0.6 5 2.4 36 3.7 2 0.9 47 1.7 14 1.8 61 1.7
Non availability of medicines 2 0.2 4 1.1 8 0.8 4 1.9 45 4.6 5 2.4 55 2.0 13 1.7 68 1.9
Too Far/ No Transportation 26 3.1 6 1.7 37 3.7 89 9.1 152 5.4 6 0.8 158 4.4
Don't Trust Facility/Poor Quality Service 1 0.1 2 0.6 3 0.3 2 0.9 8 0.8 12 0.4 4 0.5 16 0.4
No One To Accompany 1 0.1 1 0.3 3 0.3 1 0.5 18 1.8 2 0.9 22 0.8 4 0.5 26 0.7
Any others 8 1.0 7 2.0 5 0.5 4 1.9 17 1.7 1 0.5 30 1.1 12 1.5 42 1.2
No problem 142 17.1 48 13.5 82 8.3 28 13.2 159 16.3 43 20.4 383 13.7 119 15.3 502 14.1
Total 828 100 356 100 990 100 212 100 974 100 211 100 2792 100 779 100 3571 100
Was there any problem in getting these medications
Yes 16 11.9 7 12.1 16 15.1 4 13.8 54 24.1 11 22.0 86 18.5 22 16.1 108 6.6
No 118 87.4 50 86.2 87 82.1 25 86.2 167 74.6 39 78.0 372 80.0 114 83.2 486 5.3
Don't know 1 0.7 1 1.7 3 2.8 3 1.3 7 1.5 1 0.7 8 6.6
Total 135 100 58 100 106 100 29 100 224 100 50 100 465 100 137 100 602 2.6
A15 Medicines taken during illness
District
State Total
N % N % N % N % N % N % N % N % N %
Any medicine taken during illness
Yes 113 83.7 45 77.6 80 75.5 25 86.2 176 78.6 38 76.0 369 79.4 108 78.8 477 79.2
No 19 14.1 13 22.4 25 23.6 4 13.8 47 21.0 11 22.0 91 19.6 28 20.4 119 19.8
Don't know 3 2.2 1 0.9 1 0.4 1 2.0 5 1.1 1 0.7 6 1.0
Base 135 100 58 100 106 100 29 100 224 100 50 100 465 100 137 100 602 100
Duration of first medicines given after fever
Same Day 27 23.9 15 33.3 36 45.0 16 64.0 56 31.8 18 47.4 119 32.2 49 45.4 168 35.2
Next Day 67 59.3 20 44.4 37 46.3 8 32.0 88 50.0 16 42.1 192 52.0 44 40.7 236 49.5
Two Days After 18 15.9 8 17.8 5 6.3 1 4.0 24 13.6 4 10.5 47 12.7 13 12.0 60 12.6
Fever
Three Days After 1 1.3 6 3.4 7 1.9 7 1.5
Fever
Four Or More Days 2 4.4 2 1.9 2 0.4
After Fever
Don‟t Know 1 0.9 1 1.3 2 1.1 4 1.1 4 0.8
Total 113 100 45 100 80 100 25 100 176 100 38 100 369 100 108 100 477 100
105
A16: Money spent on treatment while having illness

N % N % N % N % N % N % N % N %
No money 18 10.5 6 9.7 24 10.3 5 4.6 6 16.7 11 7.6 23 8.5 1 2.2

spent
<100 29 16.9 9 14.5 38 16.2 13 12.0 2 5.6 15 10.4 36 13.2 3 6.5
101-200 19 11.0 14 22.6 33 14.1 19 17.6 8 22.2 27 18.8 49 18.0 8 17.4
201-300 21 12.2 5 8.1 26 11.1 15 13.9 6 16.7 21 14.6 41 15.1 9 19.6
301 - 500 27 15.7 13 21.0 40 17.1 21 19.4 8 22.2 29 20.1 64 23.5 11 23.9
501-1000 26 15.1 8 12.9 34 14.5 24 22.2 4 11.1 28 19.4 40 14.7 6 13.0
>1000 32 18.6 7 11.3 39 16.7 11 10.2 2 5.6 13 9.0 19 7.0 8 17.4
Total 172 100 62 100 234 100 108 100 36 100 144 100 272 100 46 100
A17 : Nutritional Status of Children - MP and NIPI districts, DLHS-RCH, 2002-03
State/District Weight for age

-3SD1 -2SD2
India 20 49
MP 24 56
Raisen 19 48
Hoshangabad 18 43
Narsimhapur 27 59
Note: 1. This index is expresses in standard deviation units (SD) from the median pf the international reference
population.2 includes children who are below –2 SD from the international reference population median. * Based on
districts surveyed in Phase 1 of DLHS-RCH (2002-04)
Source: NFHS 3,NA: Not Applicable
A18:Indicators of Child Feeding Practices MP and India
Madhya Pradesh India

NFHS-3 NFHS-2 (1998- NFHS-3
(2005-06) 99) (2005-06) NFHS-2 (1998-99)
Breastfed within 1 hour of birth 15 9 24 16
Exclusively Breastfed 22 NA 46 NA
Received semi solid-solid food 52 NA 56 NA
Children stunted 40 49 39 46
Wasted 33 20 19 16
Underweight 60 54 44 47
Vitamin A supplementation 16 NA 21 NA
106
A19: Budget Allocated and Expenditure for MP
SL. Intervention Budget Planned Expenditure % of funds used

No incurred till Jan
08
1 RCH 1041162000 463731387 44 %
2 Training 116257000 25903432 22 %
3 Additionalities 2216002000 1811367442 81 %
4 NRHM 1921000000 518492870 26%
5 Immunisation 230650000 55616957 24%
6 Maternal Health 313870000 215464253 69%
7 Child Health 107960000 16327085 15%
8 JSY 1890002000 1520874508 81%
9 Immunisation 230650000 55616957 24%
10 Other 2982589000 836031648 28%
Source: * Financial and Physical progress report (2007-2008)
A20: Budget allocated and utilised by Programme in NIPI districts
Programme/Districts Budget allocated Funds utilised

Child Health
Hoshangabad 7374800 26 %
Narsimhapur 437000 -
Raisen 190427 -
MP 107960000 15 %
Infrastructure and Human resource
Hoshangabad 18,65,000 6%
Narsimhapur 8,16,000 -
Raisen 1,32,000 41 %
MP 63,941,000 95 %
Training
Hoshanagabad 4161500 5%
Raisen 2390500 15%
MP 116257000 22%
Maternal Health and JSY
Hoshanagabad 45054800 19 %
Raisen 105000 23
MP 4721614000 78
Source: * Financial and Physical progress report (2007-2008)
107
District Hospitals (A21- A37)
Table A21: Availability Of Human Resource (Clinical)

Availability Of Human Resource (Clinical)
MP
Personnel
In Position On contract
Medical Superintendent 3 2
Specialist (Medicine) 6 5
Specialist (Surgery) 5 1
Obstetrician / Gynecologist 5 0
Pediatrician 4 1
Anesthetist 4 2
Pathologist / Microbiologist 2 0
Radiologist 4 3
Dermatologist 3 2
Total No. of District Hospitals Surveyed 3
Table A22: Availability Of Human Resource

Availability Of Human Resource
MP
Personnel
In Position On contract
Nurses 132 74
Nurse working in OBS-GYNIC department 19 11
ANM / PHN 4 3
Technicians 19 17
Radiographer 8 6
Pharmacist 4 4
Table A23: Investigative and Laboratory services

Investigative and Laboratory services
MP
Yes
Hematology 1
Urine analysis 1
Pap Smear 0
Sputum 2
Histo pathology 0
Microbiology 0
Blood Urea 3
Blood Creatinen 3
Pregnancy Test 3
Coomb‟s Test 2
ELISA For HIV Test 3
VDRL Test 3
ECG 3
2D-ECHO 0
X-Ray 2
Ultrasound 3
Fully Operational Blood Bank 3
108
Table A24: Physical Infrastructure

Physical Infrastructure
MP
Yes
DH is within the block head quarter 2
Designated government building available for the DH 3
Water supply for 24 hours 3
Three- Phase connection 3
Standby facility (generator/invertors) available in working condition 3
Functional toilet facility available 3
Separate toilets for males and females 3
Table A25: Waste Disposal

Waste Disposal
MP
Yes
Incineration 1
Autoclaving / Micro waving 1
Shredder 1
Needle and Syringe destroyer 1
Any other 2
Table A26: Communication facilities

Communication facilities
MP
Telephone facility available in all section 2
Personal Computer available 3
NIC Terminal available at DH 0
Access to internet facility available at DH 1
DH outsourcing data compilation and tabulation work 0
Ambulance 7
Jeep 4
Car 2
Whether CSSD is there in DH 0
Critical care area 1
Integrated counseling and testing center (ICTC) 2
Table A27: Residential Facility for the Medical Staff

Residential Facility For The Medical Staff
MP
Available Staying In Quarter
Yes Yes
Medical Superintendent 2 2
Obstetrician 1 1
Nurses 3 3
Other staff 2 2
109
Table A28: Other Physical Facilities

Other Physical Facilities
MP
Yes
Prominent display boards regarding service availability in local language at
DH 2
Separate registration counter in DH 3
Pharmacy for drug dispensing and drug storage at DH 3
Any suggestion / complaint box kept at DH
Pharmacy of drug storage and drug dispensing at DH 3
Table A29: Wards and beds

Wards And Beds
MP
Available Total number of
Yes beds Male Female
Pediatric ward 3 48 0 0
Intensive medicine care unite 1 6 3 3
Post operative ward 3 76 40 36
Labour room 3 5 0 0
Ante Natal care ward 2 29 0 0
PNC ward 3 44 0 0
Post partum ward 2 11 0 0
Table A30: OT Equipments

OT Equipments
MP
Available Currently in use
Yes Yes
Elective OT-Major 3 3
Emergency OT / Family welfare OT 3 3
Ophthalmology / ENT OT 3 3
Orthopedic OPD 3 2
110
Table A31: Delivery Suit Unit

Delivery Suit Unit
MP
Available Currently in use
Yes Yes
Labour room (Aseptic and clean) 3 3
Delivery room 3 3
Neo-natal room 3 3
Delivery suit unit including facility of accommodation
Examination and preparation room 3 3
Labour room (Aseptic and clean) 3 3
Delivery room 3 3
Neo natal room 3 3
Scrubbing room 2 2
Table A32: Labour Ward And Neo Natal Equipment For Nursery Ward
Labour Ward And Neo Natal Equipment For Nursery Ward
MP
Available Functional
Baby incubator 4 2
Photo therapy unit 4 2
Emergency resuscitation kit baby 5 2
Radiant warmer 5 5
Room warmer 4 0
Foetal Doppler 1 0
CTG monitor 2 1
Delivery Kit 16 16
Episiotomy Kit 9 6
Forceps delivery Kit 4 4
Craniotomy 1 1
Vacuum extractor metal 2 1
Silastic vacuum extractor 2 0
111
Table A33: Emergency Obstetrics Care

Emergency Obstetrics Care
MP
Available
Yes
Obstetrician /gynecologist is available for 24 hrs 2
Anesthetist is available for 24 hrs 2
Nurse in Obs/Gynae is available for 24 hrs 2
District Hospital provides for 24 hrs surgical interventions 3
Table A34:Essential Services (During Last one month)

Essential Services (During Last One Month)
MP
Available
Yes
OPD Services 3
Emergency Services (24 Hours) 3
Referral Services 3
Is there X ray room 3
Average Daily OPD Attendance (MALE) 442
Average Daily OPD Attendance (FEMALE) 435
Table A35: MCH Services

MCH Services
MP
Yes
24-hour delivery services including normal and assisted deliveries 3
Emergency Obstetric Care including Caesarean Sections 3
Ante-natal care 3
Intra-natal care (24 - hour delivery services both normal and assisted) 3
Post-natal care 3
New born Care 3
Child care including immunization 3
MTP facility 2
Facilities under Janani Suraksha Yojana 3
Antenatal clinics organized regularly 3
Facility for normal delivery available for 24 hours 3
Facility for internal examination for gynecological conditions available at the
DH 2
Treatment for gynecological disorders like leucorrhoea, menstrual disorders
available at the DH 3
Facility for MTP (abortion) available at the DH 3
Treatment for anemia given to both pregnant as well as non-pregnant women 3
Low birth weight babies managed at the DH 3
Fixed immunization day 3
BCG and Measles vaccine given regularly in the DH 3
Treatment of children with pneumonia available at the DH 3
Management of children suffering from diarrhea with severe dehydration done
at the DH 3
112
Table A36: Other Functions and Services

Other Functions and Services
MP
Yes
Nutrition services 3
School Health programmes 3
Promotion of safe water supply and basic sanitation 3
Collection and reporting of vital statistics 3
Education about health / behaviour change communication 3
National Health Programmes including 3
HIV/AIDS control programmes 3
Table A37: Monitoring and Supervision Activities

Monitoring and Supervision Activities
MP
Yes
Medical audit in the last year 3
Rogi Kalyan Samiti (RKS) monitor your work regularly 3
Monitoring and supervision of activities of Sub-Centres and PHCs through
regular meetings 3
Monitoring of National Health Programmes 3
Computers used for accurate record maintenance 3
113
Community Health Center (A37- A58)
Table A37: Availability Of Clinical Human Resource (Clinical)

Availability Of Clinical Human Resource (Clinical)
MP
In Position On Contract
General Surgeon 7 5
Physician 4 1
Obstetrician /Gynecologist 2 1
Pediatrician 4 4
Anesthetist/ trained MO 4 3
Public Health Programme Manager 3 1
Eye surgeon 1 0
General Medical Officer 28 17
Other specialist (SPECIFY) 1 1
Total No. of CHC‟s Surveyed 9
II. Availability Of Human Resource (Support/Para Medical Staff)
Public Health Nurse (PHN) 0 0
Auxiliary Nurse Midwife (ANM) 23 20
Staff Nurse 28 15
Nurse/ Midwife 19 15
Dresser 11 7
Pharmacist/ Compounder 10 5
Lab. Technician 11 8
Radiographer 6 2
Ophthalmic Assistant 7 4
OPD Attendant 1 4
Statistical Assistant/Data Entry Operator 4 4
OT Attendant 1 1
Registration Clerk 8 3
Any other (SPECIFY) 21 19
Table A38: Availability Of Para Medical

Availability Of Para Medical
MP
Yes
Is at least one staff nurse/LHV/ANM at CHC available round the clock 9
Gynaecologist 4
Anesthetist 1
114
TableA 39:Training for MO

Training for MO
MP
Last 5 years Ever
Non Scalpel Vasectomy (NSV) training 14 0
Minilaprotomy Training 4 0
HIV/AIDS Prevention, Care and Support training 21 2
Emergency Obstetric Care (including C-Section) training 11 0
Newborn Care training 11 1
Basic Emergency Obstetric Care training 9 0
Integrated Management of Neonatal and Childhood Illnesses training 5 0
Medical Termination of Pregnancy (MTP) training 16 1
Anesthesia training to the MO 1 0
Any Other training (SPECIFY) 10 1
Table A40: Training Of Para Medical Staff

Training Of Para Medical Staff
MP
Last 5 Years Ever
Reproductive Tract Infection /Sexually transmitted infection (RTI/STI) training 15 1
Blood grouping and cross matching training 5 0
Integrated Management of Neonatal and Childhood illness (IMNCI) training 2 0
Skilled birth attendant training 16 0
Electro Cardiogram (ECG) training 0 0
Ultra sound training 0 0
Anesthesia training to other staff 0 0
Any other 8 0
Table A41: Investigative Facility

Investigative Facility
MP
ECG facility 2 2
X- Ray facility 8 5
Ultrasound facility 0 0
Table A42: Physical Infrastructure

Physical Infrastructure
Yes
CHC is within the block head quarter 8
Designated government building available for the CHC 9
Main source of water supply (piped) 5
Main source of water supply (Hand pump) 0
Water supply for 24 hours 6
Regular Power supply 4
Occasional power supply 2
Standby facility (generator/invertors) available in working condition 8
Functional toilet facility available 8
Separate toilets for males and females 7
Laundry facility available at CHC 3
115
Table A43: Waste Disposal

Waste Disposal
MP
Yes
Incineration 2
Autoclaving / Micro waving 4
Shredder 2
Needle and Syringe destroyer 6
Any other 6
No specific facility 0
Outsourcing 4
Table A44: Communication Facilities

Communication Facilities
MP
Yes
Telephone facility available in CHC 8
CHC has intercom facility 1
Whether CHC has Personal Computer 7
NIC Terminal available at CHC 1
Access to internet facility available at CHC 4
Ambulance 9
Jeep 8
Car 0
CHC have access to vehicle for transporting patients during emergency 8
Table A45: Residential Facility for Medical Staff

Residential Facility for Medical Staff
MP
Available Staying In Quarter
Yes Yes
General Surgeon 2 2
Obstetrician /Gynecologist 1 1
Pediatrician 2 2
Anesthetist 3 2
Staff Nurse 5 3
Table A46: Labour Room And Operation Theatre

Labour Room And Operation Theatre
MP
Available Currently In Use
Yes Yes
Labour Room 8 8
Operation Theatre 9 9
116
Table A47: Storage Facilities

Storage Facilities
MP
Yes
Whether CHC has separate room for drug storage 8
Separate waiting area for the patients in the OPD of CHC 7
Table A48: Laboratory

Laboratory
MP
Operational laboratory in the CHC 9

Blood Storage Facility there in the CHC 0
Table A49: Physical facilities

Physical facilities
MP
Yes
Prominent display boards regarding service availability in local language at CHC 9
Separate registration counter in CHC 7
Pharmacy for drug dispensing and drug storage at CHC 8
Any suggestion / complaint box kept at CHC 4
OPD rooms / cubicles at CHC 7
If yes number of OPD room 16
Separate waiting area in OPD for patients at CHC 5
Minor OT in the CHC 9
Injection Room and Dressing Room in the CHC 9
Emergency Room / Casualty room in the CHC 3
Patient Services 9
Total Number of functional beds in each CHC 197
Separate wards for males and females there in the CHC 7
Number of functional beds for Male 59
Number of functional beds for Female 74
Number of functional Pediatric beds 34
Table A50: furniture/ Instrument

Furniture/ Instrument
MP
Yes Yes
Delivery Table 9 9
Bed Side Screen 7 7
Saline stand 9 9
Wheel chair 5 5
Stretcher on trolley 8 8
Oxygen cylinder with regulator and Mask 9 9
BP Instrument 9 9
Instrument trolley 6 6
Instrument tray 9 9
117
Table A51: OT Equipments

OT Equipments
MP
Yes Yes
Boyles Apparatus 5 5
Cardiac monitor 0 0
Ventilator 1 0
Horizontal high pressure sterilizer 3 2
Vertical high pressure sterilizer 2/3 drum capacity 7 6
Shadow less lamp ceiling track mounted 5 4
Shadow less lamp pedestal for minor OT 8 7
Oxygen Cylinder 660 Ltrs with regulator and Mask 8 8
Nitrous oxide cylinder 1780 Ltrs 1 1
Hydraulic operation table 6 4
Emergency drug tray 9 8
IUD Insertion Kit 9 9
Normal Delivery Kit 8 8
Equipment for Neo-Natal Resuscitation 8 8
Standard Surgical Set-I 3 3
Standard Surgical Set-II Instrument 2 2
CHC Standard Surgical Set III 2 2
Standard Surgical Set IV 2 2
Standard Surgical Set V 3 3
Standard Surgical Set VI 3 3
Equipments for Anesthesia 1 1
Equipments for laboratory test and blood transfusion. 0 0
Materials Kit for blood Transfusion 1 1
Equipment for Radiology 3 3
Table A52: Laboratory Equipments

Laboratory Equipments
MP
Yes Yes
Binocular microscope with oil immersion 9 9
Refrigerator 4 3
Stool transport carrier 5 5
Centrifuge 5 5
Rapid Diagnostic Kit for Typhoid 1 1
Rapid test kit for faecal contamination 9 0
Blood culture bottles with broth 9 0
Cold Box 5 5
Rapid Plasma Reagin (RPR) test kits for syphilis 0 0
Kits for ABO blood grouping 1 0
HIV test kits 0 0
118
Table A53: Cold Equipments

Cold Equipments
MP
Yes Yes
Walk in cooler 3 3
Walk in freezer 4 4
ILR Large 7 7
ILR Small 6 6
Deep freezer Large 7 7
Deep freezer Small 4 4
Table A54: Vaccine

Vaccine
MP
Available Supply Regular
Yes Yes
BCG 9 9
DPT 9 9
OPV 9 9
MEASELES 9 9
DT 8 8
TT 9 9
Table A55: Prophlactic Drugs

Prophylactic Drugs
MP
Available
Yes
IFA Tablets 8
Vitamin A Solution 8
ORS Packets 9
Contramaxazol 9
Table A56: Essential Services

Essential Services
MP
Yes
OPD Services 9
Emergency Services (24 Hours) 9
Referral Services 9
Blood Storage Facility 0
X ray room 8
Average Daily OPD Attendance (MALE) 493
Average Daily OPD Attendance (FEMALE) 655
119
Table A57: MCH Services

MCH Services
MP
Yes
24-hour delivery services including normal and assisted deliveries 9
Emergency Obstetric Care including Caesarean Sections 1
Ante-natal care 8
Intra-natal care (24 - hour delivery services both normal and assisted) 9
Post-natal care 9
New born Care 6
Child care including immunization 9
MTP facility 7
Facilities under Janani Suraksha Yojana 9
Antenatal clinics organized regularly 9
Facility for normal delivery available for 24 hours 9
Facility for internal examination for gynecological conditions available at the CHC 5
Treatment for gynecological disorders like leucorrhoea, menstrual disorders available at the
5
CHC
Facility for MTP (abortion) available at the CHC 4
Treatment for anemia given to both pregnant as well as non-pregnant women 8
Low birth weight babies managed at the CHC 5
Fixed immunization day 9
BCG and Measles vaccine given regularly in the CHC 9
Treatment of children with pneumonia available at the CHC 9
Management of children suffering from diarrhea with severe dehydration done at the CHC 9
Table A58: Other Functions And Services

Other Functions And Services
MP
Yes
Nutrition services 7
School Health programmes 9
Promotion of safe water supply and basic sanitation 9
HIV/AIDS control programmes 9
Rogi Kalyan Samiti (RKS) monitor your work regularly 3
120
Primary Health Centre (A59-A70)
Table A59: Availability Of Physical Infrastructure
Hoshangab Narsimhapur Raisen Total

ad
No. No. No. No.
Is a designated government building available for the PHC 7 5 3 15
Rent free / Panchayat / Voluntary 0 0 1 1
Others 0 0 1 1
PHC in sub centre building 0 0 1 1
Pipe 0 0 2 2
Bore well/Tube well 4 3 1 8
Hand pump 4 3 1 8
Is there water supply for 24 hours in PHC 7 3 2 12
Total No. of PHC‟s Surveyed 7 5 5 17
Table A60: Electricity, Toilet And Waste Disposal Availability
Hoshanga Narsimhapur Raisen Total

bad
No. No. No. No.
Regular power supply 0 3 0 3
Occasional power supply 0 0 1 1
Regular power cut 7 1 3 11
No electricity connection 0 1 1 2
Is standby facility of generator/invertors available in working
6 2 2 10
condition?
Is functional toilet facility available? 7 2 4 13
Is there a separate toilet facilities for males and females? 3 1 3 7
Bury in pit 7 5 4 16
Thrown in common / public disposal Pit 3 1 1 5
Burning 4 4 3 11
Any other 1 0 0 1
Total No. Of PHC‟s Surveyed 7 5 5 17
121
Table A61: Communication, Quarters, Operation Theatres Facility

Hoshang Narsimhapur Raisen Total
abad
No. No. No. No.
Does PHC has Government provided Telephone /Mobile phone 3 3 2 8
facility?
Whether Personal Computer available or not? 2 2 1 5
Is connectivity to NIC terminal available at PHC? 0 1 0 1
Is access to Internet facility available at PHC? 1 0 0 1
Does PHC have access to vehicle/ambulance for transporting 1 1
0 0
patients during emergencies
Is there any complaint box/suggestion box kept at PHC? 2 2 4
Available: Medical Officer 5 2 3 10
Whether residing: Medical Officer 1 2 1 4
Available: Pharmacist 2 0 1 3
Whether residing: Pharmacist 2 0 1 3
Available: LHV 4 2 2 8
Whether residing: LHV 2 0 1 3
Available: Staff Nurse 0 3 3 6
Whether residing :Staff Nurse 0 2 2 4
Available separately: Labour Room 7 3 4 14
Currently in use: Labour Room 7 2 4 13
Available separately: Operation Theatre 4 1 2 7
Currently in use :Operation Theatre 2 1 2 5
Table A62: Availability of Human Resource

District
No. No. No. No.
Medical Officer 7 2 3 12
Lady Medical Officer 1 1 1 3
AYUSH Medical Officer 2 1 3 6
Medical Officer Contractual 3 3 1 7
Staff Nurse 1 4 1 6
Pharmacist 2 1 1 4
LHV/Health Assistant 5 4 3 12
Male Health Assistant 5 3 4 12
Laboratory Technician 3 1 2 6
ANM/ Female Health Worker 7 1 3 11
Additional Staff 6 2 2 10
Nurse/ANM(Contractual)
Class IV Employee 7 5 4 16
Any Other 3 2 1 6
Table A63: Type of Training received in 5 years

Number OF PHCs where: Hoshangabad Narsimhapur Raisen Total
No. No. No. No.
Any training programme was organized last year 5 3 4 12
Pulse Polio Training organized last year 4 3 3 10
Training of ASHA organized last year 2 1 2 5
Training for ANM / Male Health Worker organized last year 1 1 1 3
Any other training organized last year 1 0 0 1
122
Table A64: Training received in last 5 years
Type of Training MO Hoshangabad Narsimhapur Raisen Total

Received
Training No. No. No. No.
In Last 5 4 2 4 10
Integrated skill development training for 12 days Year
(RCH-1)
Ever 1 0 0 1
In Last 5 2 1 4 7
Vector Born Disease Control Programme (VBDCP) Year
training
Ever 1 0 0 1
In Last 5 4 4 5 13
Directly Observed Treatment- Short Course (DOTS) Year
training
Ever 0 0 1 1
In Last 5
Year
2 4 1 7
Immunization training
Ever 5 4 4 13
In Last 5 2 1 2 5
NSV-Non Scalpel Vasectomy training Year
Ever 5 4 3 12
In Last 5 1 2 1 4
MTP- Medical Termination of Pregnancy training Year
Ever 1 0 0 1
Table A65: Special Skill Training received in Last 5 years
Type of Training MO Received Hoshangab Narsimhapur Raisen Total

Training ad
No. No. No. No.
In Last 5 Year 1 0 2 3
Minilap training
Ever 0 0 1 1
Last 5 year: Reproductive Tract Infection/Sexually In Last 5 Year 3 2 3 8
Transmitted Infection (RTI/STI) training Ever 0 0 0 0
Ever 0 0 1 1
IMNCI- Integrated Management of Neonatal and In Last 5 Year 2 4 3 9
Childhood Illnesses training Ever 5 1 2 8
Skilled Birth Attendant training
Ever 1 0 0 1
Any other training In Last 5
Year 1 2 0 3
Specify Leprosy, HIV 0 1 0 1
Fileria,
Malaria
1 1 0 2
123
Table A66: Physical facilities

No. No. No. No.
Number of PHC‟s having in-patient facility 7 4 4 15
Number of functional beds available in the surveyed PHC‟s 7 4 4 15
Number of PHC‟s having separate wards for males and females 3 1 4 8
Number of functional beds for Male available in surveyed PHC‟s 3 1 4 8
Number of functional beds for Female available in surveyed PHC‟s 3 1 4 8
Number of PHC‟s having functional Pediatric beds 3 1 4 8
Number of PHC‟s having separate room for drug storage 6 5 4 15
Table A67: Availability of Selected Furniture/Instrument

No. No. No. No.
Number of PHC‟s where:
Available 6 5 5 16
Examination Table
Functional 6 5 5 16
Available 7 4 4 15
Delivery Table
Functional 7 3 3 13
Available 6 4 4 14
Footstep
Functional 6 4 4 14
Available 2 3 3 8
Bed Side Screen
Functional 1 1 2 4
Available 6 5 5 16
Stool for patients
Functional 4 5 5 14
Available 0 2 2 4
Arm board for adult & child
Functional 0 2 1 3
Available 7 3 5 15
Saline stand
Functional 7 3 5 15
Available 0 1 2 3
Wheel chair
Functional 0 0 1 1
Available 1 2 3 6
Stretcher on trolley
Functional 1 2 3 6
Available 4 3 3 10
Oxygen trolley
Functional 3 3 3 9
Available 3 2 2 7
Height measuring stand
Functional 3 2 2 7
Available 7 2 3 12
Iron bed
Functional 7 2 2 11
Available 3 1 3 7
Bed side locker
Functional 3 1 3 7
Available 0 3 5 8
Dressing trolley
Functional 0 3 5 6
Available 0 1 2 3
Mayo trolley
Functional 0 1 2 3
Available 2 1 3 6
Instrument cabinet
Functional 2 1 2 5
Available 2 1 2 5
Instrument trolley
Functional 2 0 2 4
Available 6 5 4 15
Bucket
Functional 6 5 4 15
Available 5 3 4 12
Attendant stool
Functional 5 3 4 12
Available 7 4 5 16
Instrument tray
Functional 6 4 5 15
Chair Available 7 5 4 16
124

No. No. No. No.
Functional 7 5 4 16
Available 7 4 5 16
Wooden table
Functional 7 4 4 15
Available 7 5 5 17
Almirah
Functional 7 5 5 17
Available 3 4 2 9
Swab rack
Functional 3 4 2 9
Available 7 4 3 14
Mattress
Functional 7 3 3 13
Available 4 4 4 12
Pillow
Functional 4 4 4 12
Available 7 5 5 17
Waiting bench for patients / attendants
Functional 7 5 5 17
Available 4 3 4 11
Medicine cabinet
Functional 4 3 4 11
Available 2 1 1 4
Side rail
Functional 2 1 1 4
Available 5 1 4 10
Rack
Functional 4 0 4 8
Available 3 1 4 8
Bed side attendant chair
Functional 3 0 4 7
Available 3 0 1 4
Others
Functional 3 0 1 4
Table 68: Availability of Equipments
Hoshangaba Narsimhapur Raisen Total

d
No. No. No. No.
A. NEWBORN CARE
EQUIPEMENTS
Available 5 2 2 9
Infant resuscitation bag with mask
Functional 5 2 2 9
Available 6 4 3 13
Weighing machine
Functional 6 4 3 13
Available 3 2 3 8
Paddle operated suction machine
Functional 2 2 2 6
Available 1 2 3 6
Mounted lamp with bulb
Functional 1 2 3 6
Available 2 4 3 9
Baby Bassinet
Functional 2 4 3 9
B. OTHER EQUIPMENTS
Available 6 3 4 13
Normal Delivery Kit
Functional 5 2 4 11
Available 2 0 2 4
Equipment for assisted vacuum delivery
Functional 2 0 2 4
Available 1 0 3 4
Equipment for assisted forceps delivery
Functional 1 0 3 4
Equipment for New Born Care and Available 2 1 2 5
Neonatal Resuscitation Functional 1 1 2 4
Standard Surgical Set (for minor Available 1 2 2 5
procedures like episiotomies stitching) Functional 1 2 2 5
Equipment for Manual Vacuum Available 0 0 2 2
125
Aspiration Functional 0 0 2 2
Available 1 1 2 4
Baby warmer/incubator.
Functional 1 1 2 4
C. COLD CHAIN EQUIPEMENT
Available 4 1 3 8
Ice Lined Refrigerator (Large)
Functional 4 1 3 8
Available 4 3 3 10
Ice Lined Refrigerator (Small)
Functional 3 3 3 9
Available 4 2 3 9
Deep Freezer Large
Functional 4 2 3 9
Available 1 3 3 7
Deep Freezer Small
Functional 1 3 3 7
Available 5 4 3 12
Cold Box
Functional 5 3 3 11
Available 7 4 4 15
Vaccine Carrier
Functional 7 4 4 15
D. REQUIREMENT OF THE LAB
Available 2 1 2 5
Chemical for Hb estimation
Functional 2 1 2 5
Reagent strips for urine albumin Available 0 3 2 5
and urine sugar analysis Functional 0 2 2 4
Plasma Reagin (RPR) test kits for Available 2 0 2 4
syphilis Functional 2 0 2 4
Residual chlorine in drinking water Available 1 1 1 3
testing strips Reagents for Functional 1 1 1 3
peripheral blood smear examination
Available 1 0 1 2
Centrifuge
Functional 0 1 1
Available 4 2 1 7
Light Microscope
Functional 3 2 1 6
Available 2 0 1 3
Binocular Microscope
Functional 1 0 1 2
E. Vaccines
Availability 4 3 4 11
BCG Supply 4 3 4 11
regular
DPT Supply 4 3 4 11
regular
OPV Supply 4 3 4 11
regular
Measles Supply 4 3 4 11
regular
DT Supply 4 3 4 11
regular
TT Supply 4 3 4 11
regular
F. PROPHYLACTIC DRUGS
IFA Tablets Supply 5 3 5 13
regular
Vitamin A Solution Supply 4 4 5 13
regular
126
ORS Packets Supply 6 5 5 16
regular
Contrimaxazole Supply 4 4 5 13
regular
Table 68: Availability of Equipments
Kit A Drugs (sub-centre)
Functional 3 3 5 11
Kit B Drugs (sub-centre)
Functional 3 3 5 11
Kit C Equipments (sub-centre)
Functional 3 1 2 6
Kit D Equipments (PHC)
Functional 3 1 2 6
Kit of Essential obstetric care drugs Availability 3 2 2 7
(PHC) Functional 2 2 2 6
Table 69: Availability of Services
District Total
Hoshangabad Narsimhapur Hoshangabad
Number of PHC‟s where: No. No. No. No.
OPD Services 7 5 5 17
Emergency Services (24 Hours) 7 4 3 14
available
Referral Services 7 5 4 16
a. Average Daily OPD Attendance- 7 5 5 17
Males
b. Average Daily OPD Attendance- 7 5 5 17
Females
B.MCH CARE (SERVICE 6 2 5 13
AVAILABILITY)
Ante-natal care 7 3 4 14
Intra-natal care (24 - hour delivery 7 3 4 14
services both normal and assisted)
Post-natal care 5 2 4 11
New born Care 7 4 4 15
Child care including immunization 2 1 1 4
MTP 6 3 4 13
Facilities under Janani Suraksha 7 4 5 16
Yojana
Are antenatal clinics organized by 7 4 4 15
the PHC regularly?
Is the facility for normal delivery 4 3 4 11
available in the PHC for 24 hours?
Is the facility for internal examination 1 2 3 6
for gynecological conditions
available at the PHC?
Is the treatment for gynecological 1 0 1 2
disorders like leucorrhoea, menstrual
disorders available at the PHC?
Is the facility for MTP (abortion) 6 5 5 16
available at the PHC?
Is treatment for anemia given to both 7 5 5 17
pregnant as well as non-pregnant
women?
127
Sub Center (A70-A77)
Table A70: Sub Center Tables Availability of Staff

District Total
Staff at Sub center N % N % N % N %
ANM/Female Health Worker Yes 29 90.6 30 96.8 27 90.0 86 92.5
No 3 9.4 1 3.2 3 10.0 7 7.5
Male Health Worker Yes 23 71.9 27 87.1 22 73.3 72 77.4
No 9 28.1 4 12.9 8 26.7 21 22.6
Part Time Attendant/Additional Yes 5 15.6 1 3.2 4 13.3 10 10.8
ANM (Contractual) No 27 84.4 30 96.8 26 86.7 83 89.2
Total 32 100 31 100 30 100 93 100
Table A71: Training attended by SC staff

District Total
Hoshangabad Narshimhapur Raisen
Training Attended by SC staff N % N % N % N %
Last 5 Year Integrated skill 14 48.3 27 90.0 24 88.9 65 75.6
development training for 12 days
Ever: Integrated skill development 8 53.3 1 33.3 2 66.7 11 52.4
training for 12 days
Last 5 Year-VBDCP training 15 51.7 12 40.0 22 81.5 49 57.0
Ever -VBDCP training 9 64.3 2 11.1 3 60.0 14 37.8
Last five years (DOTS) training 22 75.9 27 90.0 27 100 76 88.4
Ever DOTS training 2 28.6 2 20.0
Last 5 year Immunization training 18 62.1 30 100 27 100 75 87.2
Ever Immunization training 5 45.5 5 45.5
Last 5 year IUD Insertion 12 41.4 21 70.0 26 96.3 59 68.6
Ever: IUD Insertion 9 52.9 7 77.8 1 100 17 63.0
Last 5 years IMNCI training 7 24.1 22 73.3 26 96.3 55 64.0
Ever IMNCI training 7 31.8 5 62.5 1 100 13 41.9
Last 5 year Skilled Birth Attendant 9 31.0 22 73.3 26 96.3 57 66.3
training
Ever -Skilled Birth Attendant training 2 10.0 3 37.5 1 100 6 20.7
Table A72: AVAILABILITY AND FUNCTIONAL STATUS OF FURNITURE AT SUB CENTER

District Total
Hoshangabad Narshimhapur Raisen
Furniture at Sub Center level N % N % N % N %
Available Examination Table 16 50.0 21 67.7 9 30.0 46 49.5
Functional Examination Table 13 81.3 19 90.5 7 77.8 39 84.8
Available Labour Table 11 34.4 18 58.1 4 13.3 33 35.5
Functional Labour Table 6 54.5 17 94.4 4 100 27 81.8
Available Foot Step 12 37.5 20 64.5 5 16.7 37 39.8
Functional Foot Step 9 75.0 19 95.0 4 80.0 32 86.5
Available Cupboard with lock and 14 43.8 26 83.9 11 36.7 51 54.8
key
Functional Cupboard with lock and 13 92.9 26 100 8 72.7 47 92.2
key
Available Bedside Screen 5 15.6 20 64.5 4 13.3 29 31.2
Functional -Bedside Screen 4 80.0 20 100 4 100 28 96.6
128
TableA73: AVAILABILITY AND FUNCTIONAL STATUS OF EQUIPMENTS IN SURVEYED SC‟s

District Total
Equipment N % N % N % N %
Available-Instrument Sterilizer 24 75.0 27 87.1 26 86.7 77 82.8
Functional-Instrument Sterilizer 18 75.0 16 59.3 25 96.2 59 76.6
Available-Auto Disposable (AD) 30 93.8 30 96.8 27 90.0 87 93.5
Syringes
Functional-Auto Disposable (AD) 30 100 26 86.7 26 96.3 82 94.3
Syringes
Available-Hub Cutter 30 93.8 17 54.8 19 63.3 66 71.0
Functional-Hub Cutter 29 96.7 11 64.7 18 94.7 58 87.9
Available-B.P. Instrument 21 65.6 28 90.3 22 73.3 71 76.3
Functional-B.P. Instrument 11 52.4 20 71.4 17 77.3 48 67.6
Available-Stethoscope 13 40.6 23 74.2 24 80.0 60 64.5
Functional-Stethoscope 9 69.2 16 69.6 21 87.5 46 76.7
Available-Weighing machine (adult) 27 84.4 30 96.8 28 93.3 85 91.4
Functional-Weighing machine 25 92.6 28 93.3 26 92.9 79 92.9
(adult)
Available-Weighing machine (infant) 29 90.6 29 93.5 26 86.7 84 90.3
Functional-Weighing machine 27 93.1 26 89.7 18 69.2 71 84.5
(infant)
Available-Hemoglobin meter 9 28.1 28 90.3 19 63.3 56 60.2
Functional-Hemoglobin Meter 6 66.7 22 78.6 15 78.9 43 76.8
Available-Fetus scope 11 34.4 18 58.1 18 60.0 47 50.5
Functional-Fetus Scope 9 81.8 13 72.2 16 88.9 38 80.9
Available-SIMS Speculum 7 21.9 14 45.2 17 56.7 38 40.9
Functional-SIMS Speculum 7 100 14 100 15 88.2 36 94.7
Available-Vaccine Carrier 27 84.4 31 100 28 93.3 86 92.5
Functional-Vaccine Carrier 27 100 29 93.5 27 96.4 83 96.5
Table A74: Availability of Essential Kits (with equipments)

District Total
Essential Kits N % N % N % N %
Drug Kit-A 21 65.6 10 32.3 28 93.3 59 63.4
Drug Kit-B 16 50.0 9 29.0 28 93.3 53 57.0
Drug Kit-C 12 37.5 10 32.3 23 76.7 45 48.4
IFA Tablets 27 84.4 19 61.3 28 93.3 74 79.6
Vitamin A Solution 18 56.3 28 90.3 28 93.3 74 79.6
ORS Packets 28 87.5 28 90.3 28 93.3 84 90.3
Cotrimaxazole tablet (Pediatric) 25 78.1 20 64.5 28 93.3 73 78.5
Disposal Delivery Kit 9 28.1 18 58.1 15 50.0 42 45.2
TableA75: Labour room availability

District Total
Labour room N % N % N % N %
Whether the Sub-Center is having a 10 31.3 14 45.2 3 10.0 27 29.0
Labour room
If Labour room is present, are 2 20.0 2 7.4
deliveries carried out in the Labour
room
Deliveries conducted in the last 10 100 14 100 3 100 27 100
three months
129
TableA76: Availability of specific service & Other Services

District Total
Other Service at Sub center level N % N % N % N %
Any doctor visit the Sub-center at least once 14 43.8 25 80.6 22 73.3 61 65.6
in a month
Is the day and time of this visit fixed 7 50.0 9 36.0 14 63.6 30 49.2
Are the residents of the village aware of the 7 50.0 5 20.0 14 63.6 26 42.6
timings of the doctor's visit
Does the Health Assistant (male) or LHV 27 84.4 24 77.4 22 73.3 73 78.5
visit the Sub-Center at least once a week
Is the Antenatal care T.T, IFA tablets, 21 65.6 19 61.3 26 86.7 66 71.0
weight and BP checkup) provided by those
in the Sub center
Facility for referral of complicated cases of 20 62.5 25 80.6 25 83.3 70 75.3
pregnancy / delivery available at Sub center
for 24 hours
ANM/any trained personnel accompany the 32 100 26 83.9 29 96.7 87 93.5
woman in Labour to the referred care facility
at the time of referral
Immunization services as per Government 31 96.9 31 100 30 100 92 98.9
schedule provided by the Sub-center
ORS for prevention of diarrhea and 31 96.9 31 100 28 93.3 90 96.8
dehydration available in the Sub-center
Contraceptive services like insertion of 32 100 31 100 29 96.7 92 98.9
Copper-T, distributing Oral contraceptive
pills or condoms provided by the Sub center
Disease surveillance 32 100 31 100 29 96.7 92 98.9
Control of local endemic diseases 32 100 31 100 28 93.3 91 97.8
Promotion of sanitation 32 100 31 100 29 96.7 92 98.9
Field visits and home care 32 100 31 100 29 96.7 92 98.9
National Health Program including 31 96.9 31 100 28 93.3 90 96.8
HIV/AIDS control program
Table A 76:Monitoring and Supervision activity

District Total
N % N % N % N %
Have you prepared the Sub-Center plan for 18 56.3 28 90.3 19 63.3 65 69.9
this year
Registers 17 53.1 31 100 29 96.7 77 82.8
Reports 15 46.9 31 100 28 93.3 74 79.6
Immunization Card 30 93.8 30 96.8 28 93.3 88 94.6
ANC Card 29 90.6 25 80.6 29 96.7 83 89.2
Any Other 2 6.3 1 3.3 3 3.2
Training of traditional/Skilled birth 30 93.8 30 96.8 30 100 90 96.8
attendants and ASHA
Coordinated services with AWWs, ASHA, 31 96.9 30 96.8 27 90.0 88 94.6
Village Health and Sanitation Committee,
PRIs
Coordination and supervision of activities of 30 93.8 28 90.3 27 90.0 85 91.4
ASHA
Proper maintenance of records and 31 96.9 31 100 30 100 92 98.9
registers
Is there a Village Health Plan / Sub Centre 27 84.4 16 51.6 23 76.7 66 71.0
Plan?
Is the scheme of ASHA implemented in Sub 29 90.6 29 93.5 26 86.7 84 90.3
Centre
Any woman from the Sub- Centre villages 6 18.8 1 3.2 3 10.0 10 10.8
die during pregnancy, delivery or during six
weeks after delivery since 1 April 2007 to 31
March 2008?
130
Table A77: Maternal and Newborn Deaths in the sub center area
District Total
Maternal and New born deaths N % N % N % N %
Number of such maternal deaths, since 1 6 100 1 100 1 100 8 100
April 2007 to 31 March 2008
RECORD AVAILABLE 6 100 1 100 7 87.5
Number of newborn deaths, since 1 April 26 81.3 23 74.2 20 66.7 69 74.2
2007 to 31 March 2008
RECORD AVAILABLE 21 65.6 23 74.2 16 53.3 60 64.5
Number of infant deaths, since 1 April 2007 29 90.6 30 96.8 29 96.7 88 94.6
to 31 March 2008
Any other 2 6.3 1 3.3 3 3.2
Total 32 100 31 100 30 100 93 100
131

Baseline Survey On Child and Related Maternal Health Care-Revised Report - Madhya Pradesh-491 - 1

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Baseline Survey On Child and Related Maternal Health Care-Revised Report - Madhya Pradesh-491 - 1

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NIPI Baseline Report – Madhya Pradesh

Revised Report – MADHYA PRADESH

Mr. P.K. Hota

Project No: 193318

Baseline Summary Indicators 1–3

1.1 Background of NIPI 4

Chapter 2 Household Characteristics 23

2.1 Household demographic profile 23

Chapter 3 Characteristics of Survey Respondents 36

3.1 Background characteristics 36

Chapter 4 Maternal Health 41

4.2.1 Pregnancy registration and ANC provider 42

Chapter 5 Newborn Care 67

Chapter 6 Child Morbidity and Treatment 74

6.1 Prevalence of illness in children under study 74

Chapter 7 Child Immunization 81

Chapter 8 Status of health facilities and Health Management Information System 88

8.4.1 Physical Infrastructure/facilities 91

LIST OF TABLES Page No.

Table 1.1: Key health Indicators of the state 7

Table 2.10:Type of house, NIPI-08 27

Table 4.14:Person persuaded for treatment during pregnancy, NIPI-08 51

Table 4.23:Nature of advice received after delivery by source, NIPI-08 57

Table 5.9: Feeding of prelacteal liquids, NIPI-08 73 72

Table 6.9: Duration of treatment sought during illness, NIPI-08 78

Table 7.10:Dropout rate 87

LIS OF FIGURES Page No.

Figure 4.1: Registration of pregnancies by type of facilities 42

A1 Household possession – NIPI districts 96

1.1 Background of NIPI

Efforts of Norway India Partnership Initiative

 Strengthening the National Rural Health Mission, by supporting an independently

1.2 Research Objectives

1.3 Study Phases

This current baseline study comprises of three phases, viz.,

1.4 Study Area

1.5 Ongoing health related programs in MP

1.6 Demographic profile of NIPI states

1.6.1 About Madhya Pradesh and NIPI states

Year Gross State Domestic Product

Table 1.1: Key health Indicators of the state

Health care indicators Sources MP

1.6.2 Profile of Hoshangabad district

FACT SHEET, DISTRICT - HOSHANGABAD, MP

1.6.3 Profile of Narsimhapur district

The Urbanization rate in the district is

In Narsimhapur district, there are 2

Specific schemes are working for the

FACT SHEET, DISTRICT - NARASIMHAPUR, MP

Child Immunization and Vitamin A supplementation:

1.6.4 Profile of Raisen district

Males constitute 53%

The economy of the

FACT SHEET, DISTRICT - RAISEN, MP

1.7 Survey Design

1.7.1 Sampling strategy at district level

 Oral informed consent of the selected respondent

 Sample size determination in NIPI Baseline study

Sample size determination in NIPI Baseline study

P1 = the estimated proportion at the time of the baseline survey;

 =0.05 (Z1- = 1.96); =0.20 (Z1-=0.84); D = 2

Indicator State D Sample Size

Primary sampling units