Escolar Documentos
Profissional Documentos
Cultura Documentos
Prepared For:
Client Contact:
Mr P.K. Hota
TNS Consultant:
Sandeep Ghosh
TNS India Private Limited
7th Floor, Block 4-B
DLF Corporate Park, DLF City
Phase –III, MG Road
Gurgoan 122002
India
e: sandeep.ghosh@tns-global.com
August , 2009
NIPI Baseline Report – Orissa
CONTENTS
Page No.
Chapter 1 Introduction 1
i
NIPI Baseline Report – Orissa
4.1 Preamble 39
4.2 Antenatal Care 39
4.2.1 Pregnancy registration and ANC provider 39
4.2.2 Timing and number of ANC 42
4.2.3 Components of Antenatal Care 43
4.2.4 Health problems and treatment seeking behaviour during pregnancy 46
4.3 Delivery Care 49
4.3.1 Influence of background characteristics choice of place of delivery 50
4.3.2 Arrangement and cost of transport 52
4.3.3 Institutional delivery 52
4.3.4 Janani Suraksha Yojana (JSY) 55
4.3.5 Training and capacity building of ASHA‘s 56
4.3.6 Home deliveries 58
4.4 Postnatal care 63
4.5 Maternal Mortality 64
5.1 Preamble 65
5.2 Infant Mortality 65
5.3 Child Mortality 65
5.4 Birth weight 66
5.5 Neonatal checkups 67
5.6 Breastfeeding and supplementation 68
7.1 Preamble 81
7.2 Vaccination coverage 81
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 and other infrastructure at District hospital 88
8.2.4 Availability of Beds 88
8.2.5 Operation Theater 89
8.2.6 Neonatal equipments and Nursery services 89
ii
NIPI Baseline Report – Orissa
iii
NIPI Baseline Report – Orissa
LIST OF TABLES
Page No.
iv
NIPI Baseline Report – Orissa
v
NIPI Baseline Report – Orissa
vi
NIPI Baseline Report – Orissa
vii
NIPI Baseline Report – Orissa
FACT SHEETS
District: ANGUL
Baseline Summary Indicators
Indicator Total %
Mothers registered in the first trimester when they were pregnant with last live birth/still birth 563 52.3
Mothers who had at least 3 Ante-Natal Care visits during the last pregnancy 670 62.3
Total number of deliveries (home plus institutional) 1161
Institutional deliveries 760 65.5
Average Retention period (hours) in case of institutional delivery 51
Post natal care provided to mother and neonates - Children had check-up within 24 hours after delivery 327 28.2
(based on last live birth)
Post natal care provided to mother and neonates -Children had check-up within 10 days after delivery 433 37.3
(based on last live birth)
Mothers who received post natal care within 48 hours of delivery of their last child 116 10.0
Referral done for mothers with illness and complications during pregnancy 232 73.7
Children with Diarrhoea in the last two weeks who received ORS 32 50.8
Children with Diarrhoea in the last two weeks who were given treatment 47 74.6
Children with acute respiratory infection/fever in the last two weeks who were given treatment 78 54.2
Children (age 6 months above) exclusively breastfed 270 30.6
Children (12-23 months) fully immunized (BCG, 3 doses each of DPT, and Polio and Measles) 229 60.9
New born Babies immunized with zero dose polio and BCG 192 51.1
New born Babies – breastfed within 1 hour of birth 684 59.2
Newborn with birth weight taken after delivery at home 24 6.0
District: SAMBALPUR
Baseline Summary Indicators
Indicator Total %
Mothers registered in the first trimester when they were pregnant with last live birth/still birth 617 53.5
Mothers who had at least 3 Ante-Natal Care visits during the last pregnancy 938 81.1
Total number of deliveries (home plus institutional) 1176
Institutional deliveries 920 78.2
Average Retention period (hours) in case of institutional delivery 78
Post natal care provided to mother and neonates - Children had check-up within 24 hours after 615 52.3
delivery (based on last live birth)
Post natal care provided to mother and neonates -Children had check-up within 10 days after delivery 803 68.3
(based on last live birth)
Mothers who received post natal care within 48 hours of delivery of their last child 535 45.5
Referral done for mothers with illness and complications during pregnancy 407 87.2
Children with Diarrhoea in the last two weeks who received ORS 48 54.5
Children with Diarrhoea in the last two weeks who were given treatment 73 83.0
Children with acute respiratory infection/fever in the last two weeks who were given treatment 103 57.5
Children (age 6 months above) exclusively breastfed 408 47.8
Children (12-23 months) fully immunized (BCG, 3 doses each of DPT, and Polio and Measles) 350 77.6
New born Babies immunized with zero dose polio and BCG 253 56.1
New born Babies – breastfed within 1 hour of birth 788 67.9
Newborn with birth weight taken after delivery at home 58 22.7
viii
NIPI Baseline Report – Orissa
District: JHARSUGUDA
Baseline Summary Indicators
Indicator Total %
Mothers registered in the first trimester when they were pregnant with last live birth/still birth 553 47.4
Mothers who had at least 3 Ante-Natal Care visits during the last pregnancy 986 84.6
Total number of deliveries (home plus institutional) 1186
Institutional deliveries 907 76.5
Average Retention period (hours) in case of institutional delivery 63
Post natal care provided to mother and neonates - Children had check-up within 24 hours after delivery (based 453 38.2
on last live birth)
Post natal care provided to mother and neonates -Children had check-up within 10 days after delivery (based 637 37.5
on last live birth)
Mothers who received post natal care within 48 hours of delivery of their last child 210 17.8
Referral done for mothers with illness and complications during pregnancy 231 83.1
Children with Diarrhoea in the last two weeks who received ORS 51 53.1
Children with Diarrhoea in the last two weeks who were given treatment 69 94.6
Children with acute respiratory infection/fever in the last two weeks who were given treatment 85 55.9
Children (age 6 months above) exclusively breastfed 411 48.2
Children (12-23 months) fully immunized (BCG, 3 doses each of DPT, and Polio and Measles) 377 84.2
New born Babies immunized with zero dose polio and BCG 192 42.9
New born Babies – breastfed within 1 hour of birth 767 65.2
Newborn with birth weight taken after delivery at home 123 45.4
ix
NIPI Baseline Report – Orissa
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)
For India‘s success in achieving Millennium Development Goal four (MDG 4), Norway-India
Partnership Initiative (NIPI) is 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
1
NIPI Baseline Report – Orissa
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
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 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.
In this baseline survey, the data were collected from the three NIPI focus Districts; Angul,
Jharsuguda and Sambalpur and relevant information from the State level. The Districts selected
by NIPI in consultation with the State NRHM for implementation of the interventions.
In order to improve the implementation of several child and related maternal health activities,
certain programs are ongoing programs currently such as of Janani Suraksha Yojana, Janani
Express, Yashoda, Mamta Divas, Pustikar Diwas and IMNCI (Integrated Management of
Neonatal Childhood) program.
2
NIPI Baseline Report – Orissa
Orissa is a state located on the east coast of India, by the Bay of Bengal. It was established on 1
April 1936 as a province in British India and consists predominantly of Oriya speakers. 1 April is
therefore celebrated as Utkal Divas (Orissa Day).
Orissa is the ninth largest state by area and the eleventh largest by population. Oriya is the
official and most widely spoken language. Orissa has a relatively unindented coastline (about 480
km long) and lacks good ports, except for the deepwater facility at Paradip. The narrow, level
coastal strip, including the Mahanadi River delta supports the bulk of the population. The interior
of the state is mountainous and sparsely populated.
Orissa is predominantly an agricultural state, although it has been changing rapidly. Paddy is the
main crop of the state. Other crops, including pulses, oil seed, jute, mustard, turmeric and
sugarcane, are also extensively cultivated. Orissa is one of the maritime states of India, and it has
a long coastline.
According to the 2001 Census, Orissa had a population of 36.7 million, accounting for 4 percent
of the total population of India. Population density is lower in Orissa than in India as a whole (236
compared with 325 persons per square kilometre).
There are 30 Districts in Orissa —In Orissa, three Districts namely Angul, Jharsuguda and
Sambalpur are selected by NIPI for specific intervention programs.
The following chart provides a view of the trend of gross state domestic product of Orissa at
market prices estimated by Ministry of Statistics and Programme Implementation, GoO with
figures in millions of Rupees.
3
NIPI Baseline Report – Orissa
Orissa's gross state domestic product for 2004 is estimated at $18 billion in current prices.
Following India's independence, Orissa has not been a focus of investment by the central
government, causing its infrastructure and educational standards to lag behind the rest of the
nation. For instance, only about 20% of the road network is paved. In rural areas over 65% of the
population have no access to safe drinking water.
Orissa is connected to India through roads, railways, airports, and seaports. Bhubaneswar is well
connected by air, rail and road with the rest of India. The Biju Patnaik airport is being expanded to
accommodate wide bodied aircraft.
According to the 2001 census of India, the total population of Orissa is 36,706,920, of which
18,612,340 (50.89%) are male and 18,094,580 (49.11%) are female, or 972 females per 1000
males. This represents a 16.25% increase over the population in 1991. The population density is
236 per km² and 85.01% of the people live in rural areas and 14.99% live in urban areas.
34,726,129 of the population are Hindu, 897,861 are Christian, 761,985 are Muslim, 17,492 are
Sikhs, 9,863 are Buddhist, and with the remainder belonging to other religions.
The literacy rate is 63.61% with 75.95% of males and 50.97% of females being literate. The
proportion of people living below the poverty line in 1999–2000 was 47.15% which is nearly
double the all India average of 26.10%. Scheduled Castes and Tribes form 16.53% and 22.13%
of the population state, constituting 38.66% of the State population.
Data of 1996–2001 showed the life expectancy in the state was 61.64 years, higher than the
national value of years. The state has a birth rate of 23.2%, a death rate of 9.1 %, an infant
mortality rate of 65 per 1000 live birth and a maternal mortality rate of 358 per 1,00,000 live births
. Orissa has a HDI of 0.579 in 2004.
4
NIPI Baseline Report – Orissa
Complete ANC
N.F.H.S.-I 35%
N.F.H.S.-II 48%
N.F.H.S.-III 61%
Safe Delivery
(2004-05 CNAA Report) 86%
(2005-06 CNAA Report) 86%
(2006-07 CNAA Report ) 88.39%
5
NIPI Baseline Report – Orissa
Angul District is a centrally located District in the state of Orissa. This District covers a
geographical area of 6232 square kilometers and is situated in the central part of Orissa.
The District has a a population of 11,39,341 as per 2001 census (Males - 5,86,903, Females -
5,52,438) with a population density of 179 per km². Angul, the District headquarters is about 150
kilometers from the state capital Bhubaneswar. It is situated on the National Highway No 42,
making it well accessible from all parts of the state.
The District Head Quarter Hospital (DHH) at Angul, three sub-divisional hospitals at Talcher,
Athamallik & Pallahara, one UGPHC, one CHC, 27 PHCs (N) cater to the health care need of the
people. There are also nine Ayurvedic & eight Homeopathic dispensaries.
Public Sector Units working in the District, namely NALCO, MCL & NTPC also have their own
health institutions, which mostly cater to their employees. NALCO has established one hospital.
NTPC has established two hospitals, one at Kaniha & the other at Talcher. MCL has established
one Hospital and eight dispensaries at Talcher coalfields. Rengali Multi Purpose Project (RMP)
authorities maintain two hospitals, one at Rengali & the other at Samal.
A Zilla Swasthya Samittee (ZSS) has been formed under the chairmanship of the Collector for
management and development of Medical wing and oversee implementation of National Health
Programmes. A scheme called five diseases treatment scheme (Panchabyadhi) started in July
2002 to cover five most common diseases namely Respiratory Tract Infection, Malaria, Scabies,
Leprosy & Diarrhoea. All medicines required for treatment of these diseases is provided free of
cost at govt. health institutions.
Reproductive & Child Health (RCH) Program is being implemented in this District since 1994.
One health sub centre has been established for every 5000 population in rural area.
Immunization, registration of pregnancy, care of pregnant women, popularization of family welfare
measures, & measures for reduction of infant mortality are some of the important activities under
RCH care. All these services are provided through health sub-centre. Registration of birth is done
at PHC level. Apart from routine immunization activities, pulse polio Immunization is being done
in a campaign made on National immunization Days since 1995. Vit ―A‖ supplementation
campaign is being done since March 1999.
6
NIPI Baseline Report – Orissa
7
NIPI Baseline Report – Orissa
Jharsuguda is a District in Orissa with Jharsuguda town as its headquarter. This region is rich in
coal and other mineral reserves. Of late, many small and medium scale iron and steel units have
been set up in the vicinity of Jharsuguda town, giving impetus to the industrial growth of the
District.
During the re-organisation of the Garhajat States in 1936 under the British, Jharsuguda formed a
st
part of Sambalpur District. The new District of Jharsuguda came into existence on 1 April, 1994
and was created by amalgamation of the er stwhile Jamindars of Rampur, Kolabira, Padampur &
Kudabaga; Jharsuguda Town is the head quarters of the new District.
As of 2001 India census, Jharsuguda had a population of 75,570. Males constitute 52% of the
population and females 48%. It has an average literacy rate of 69%, higher than the national
average of 59.5%: male literacy being 77% and female literacy at 60%. It is a one of the rich
Districts in mineral wealth, especially coal and is one of the most industrialized Districts of Orissa.
Jharsuguda town is situated at the Western end of Orissa on the State High way No. 10. It is
situated at a distance of 515 K.M. from Calcutta and 616 Km. from Nagpur.
Jhasuguda is a new District, which came into existence on 1st April-94. Previously the District HQ
Hospital was a Sub-Divisional Hospital under the erstwhile-undivided Sambalpur District. All the
constraints common to a new Districts persists here as well.
There is one Dist. Headquarter Hospital, 4 old PHCs and 14 new PHCs and 2 CHCs. There is
one government hospital at Belpahar and 63 SCs.
There are 3 other hospitals under the Health department and 4 more outside the purview of the
H&FW Department, viz.
E.S.I. Hospital, Brajrajnagar
O.S.A.P. Hospital, Jharsuguda
E.S.I. Dispensary, Jharsuguda
Railway Hospital, Jharsuguda
8
NIPI Baseline Report – Orissa
9
NIPI Baseline Report – Orissa
10
NIPI Baseline Report – Orissa
In addition, there are 3 Public Sector undertaking hospitals, viz. Central Hospital, M.C.Ltd, Ib
Thermal Hospital and Rampur Colliery Hospital. The TATA group also has a hospital called the
Tata Refractories Hospital.
The same health programs running in Angul District are running here as well. A snapshot of the
health status of Jharsuguda district is given below.
Sambalpur serves as the gateway to the beautiful Western part of Orissa. It is the divisional head
quarters of the Northern administrative division of the State - also a very important commercial
and Educational center. Presently, Sambalpur is the break-bulk city between the states of
Chhattisgarh and Orissa.
Most of the villages of the District are inaccessible during the rainy season. Presence of a number
of nallas without bridges cuts off the villages from the nearby roads. The District is served by
National Highway No.6, National Highway No.42, Major District roads and a section of South
Eastern Railways. Rural electrification has been extended to 63.6% of the villages of the District.
Telecommunication Network is not adequate to cater to the needs the people in the rural areas.
Drinking water facilities are available in villages mostly from the sources of tubewells.
11
NIPI Baseline Report – Orissa
12
NIPI Baseline Report – Orissa
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.
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.
nD
2 P(1 P) Z1 P1 (1 P1 ) P2 (1 P2 ) Z1
2
2
Where:
D = Design effect
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;
P = (P1 + P2) / 2;
13
NIPI Baseline Report – Orissa
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.
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
Sample Size
Source of Indicator State D p1 P2 Live Households Including
data births 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 deliveries Mean 2 0.26 0.19 1003* 1204*
*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. 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.
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.
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
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.
14
NIPI Baseline Report – Orissa
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.
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.
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.
As part of Quantitative survey we conducted cross-sectional survey based on the WHO and
UNICEF Rapid Assessment Procedure.
Questionnaires
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:
15
NIPI Baseline Report – Orissa
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.
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.
16
NIPI Baseline Report – Orissa
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)
Target Group Research Per Per
Technique District state
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)
17
NIPI Baseline Report – Orissa
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.
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.
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.
18
NIPI Baseline Report – Orissa
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.
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.
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.
The survey teams were visited by the central survey coordination team members on field to check
the process and quality of data collection.
19
NIPI Baseline Report – Orissa
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.
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.‖
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.
District
All NIPI Districts
Angul Jharsuguda Sambalpur
Rural Urban Rural Urban Rural Urban Rural Urban Total
N N N N N N N N N
PSU 44 6 32 18 36 14 112 38 150
No. of women 1,022 139 770 416 843 333 2,635 888 3,523
20
NIPI Baseline Report – Orissa
NIPI Baseline Report for Orissa consists of 8 Chapters including this one. Chapter -2 gives
Orissa‘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
sample 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.
21
NIPI Baseline Report – Orissa
Chapter 2
Household Characteristics
This section presents the demographic characteristics of the sample households across urban
and rural areas in the three Districts of Orissa. 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: Percent distribution of household population by age, sex and residence, All NIPI districts,
Orissa , NIPI-08
According to Census of India 2001, the sex ratio across the Orissa state was at 972 females per
1000 males. However NIPI survey consistently shows the sex ratio across urban and rural areas
is in favour of the female, which is contrary to the sex ratio of Orissa. 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. Apart from this, as per the
sampling methodology, only those households were selected where mothers of 0 to 23 months
children are available, hence those households having no eligible mothers or having only male
members are omitted.
So far as the sex ratio of children (0-6 years) is concerned, as per census 2001, there are 927
females per 1000 males in India, whereas it is 953 in Orissa. Of the three NIPI districts, Anugul
has the lowest child sex ratio (937) followed by Jharsuguda (949) and Sambalpur (937).
22
NIPI Baseline Report – Orissa
Table 2.2: Percent distribution of household population by age, sex and residence, District Angul,
Orissa, NIPI-08
Table 2.3: Percent distribution of household population by age, sex and residence, District
Jharsuguda, Orissa, NIPI-08
23
NIPI Baseline Report – Orissa
Table2.4: Percent distribution of household population by age, sex and residence, District
Sambalpur, Orissa, NIPI-08
The demographic trend across the three Districts was very similar with 25-28% being children
below age of 5 years, 6-8% being elderly (beyond 60 years) and around 50-55% being in the
working age group of 15 – 59 years.
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.
In line with the growing trend in India where economic compulsions are forcing more and more
joint family structures to break up into nuclear families, here too we find that there are more
nuclear families within the sample than joint or extended. The only exception to the trend is the
District of Jharsuguda 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
28.2%. The relatively more backward District in that sense is Angul with the highest poverty rate
while Jharsuguda appears to be relatively more developed. Consistently, the rural poverty rate is
more than double that of its urban counterpart.
24
NIPI Baseline Report – Orissa
Table 2.6: District wise percent distribution of household population by religion & caste/tribe, and
mean household size, Orissa, NIPI-08
Type of House Angul Jharsuguda Sambalpur Total
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
Religion
Hindu 99.8 99.3 99.8 98.9 93.1 96.9 97.4 96.2 97.1 98.8 95.2 97.9
Muslim 0.1 0.1 0.7 5.1 2.3 0.3 3.3 1.2 0.4 3.6 1.2
Sikh 0.7 0.1 0.9 0.3 0.1 0.3 0.2 0.0 0.6 0.2
Christian 0.4 0.9 0.6 2.2 0.3 1.6 0.8 0.5 0.7
Other 0.1 0.1 0.0 0.0
Caste/Tribe
SC 24.6 28.5 25.1 18.8 15.4 17.7 24.8 16.5 22.5 23.0 17.8 21.7
ST 20.7 4.4 18.8 37.7 19.8 31.6 38.6 25.8 35.0 31.5 19.8 28.6
OBC 39.7 43.8 40.1 36.2 39.3 37.2 29.0 33.3 30.2 35.1 37.6 35.7
General 15.0 23.4 16.0 7.4 25.6 13.5 7.6 24.4 12.3 10.4 24.8 13.9
Average number of usual members
Mean 5.6 5.7 5.6 5.7 6.1 5.8 5.3 5.5 5.4 5.5 5.8 5.6
Total HH 1070 138 1208 804 435 1239 927 367 1294 2801 940 3741
Overwhelmingly, the sample households were of Hindu faith, with a 5% share of Muslim
households only in urban Jharsuguda. Other Backward Communities (OBC) and Schedule Tribe
(ST) were the dominant social groups accounting for 36% and 29% of the households
respectively. The third major social group was Schedule Castes with the general or forward
castes being a relative minority in these Districts.
The average household size varied between 6.1 in urban Jharsuguda to 5.3 in rural Sambalpur.
The level of educational attainment of different members of the households (staring with the age
of 5 years) has been analysed on the basis of location of the PSU and gender of the household
member. The findings are presented below.
25
NIPI Baseline Report – Orissa
Table 2.8: Education attainment by gender of household member in terms of years of schooling,
NIPI-08
Angul Jharsuguda Sambalpur State Total
Male Femal Total Male Femal Total Male Femal Total Male Femal Total
e e e e
Years of % % % % % % % % % % % %
schoolin
g
No 23.9 42 33.1 15.4 29.6 22.7 23.5 38 31.1 20.8 36.4 28.8
schooling
< 5 years 20.8 19 19.9 17.4 19 18.2 17.4 17.9 17.7 18.5 18.6 18.6
complete
5-7 years 20.7 15.9 18.2 17.6 18 17.8 20 18 18.9 19.4 17.3 18.3
complete
8-9 years 15.7 12.4 14 17.6 13.7 15.7 17.1 12.7 14.8 16.8 13 14.8
complete
10-11 7.5 5.9 6.6 14 9.4 11.5 8 6 7 9.9 7.1 8.5
years
complete
12 or 11.4 4.8 8.2 18 10.3 14.1 14 7.4 10.5 14.6 7.6 11
more
years
complete
Total 100. 100.0 100. 100. 100.0 100. 100. 100.0 100. 100. 100.0 100.0
0 0 0 0 0 0 0
Total # of 2468 2595 5063 2616 2770 5386 2456 2676 5132 7540 8041 1558
members 1
Consistently across all Districts, illiteracy was higher among females. It may also be noted that
even though the level of illiteracy was lowest in Jharsuguda 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 5 years) was 52.6%.
Women members having completed their secondary level of education (10 years or more) were
proportionately higher in Jharsuguda (19.7%) as against Angul (10.8%) or Sambalpur (13.4%).
Table 2.9: Education attainment by location of PSU in terms of years of schooling, NIPI-08
Angul Jharsuguda Sambalpur State Total
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
Years of % % % % % % % % % % % %
schooling
No 35.1 18.7 33.1 24.8 19.2 22.7 35 21.4 31.1 32 19.9 28.8
schooling
< 5Years 20.4 16.3 19.9 19.3 16.3 18.2 17.7 17.6 17.7 19.2 16.8 18.6
complete
5-7 Years 18.4 17 18.2 19.6 14.8 17.8 19.3 17.9 18.9 19 16.2 18.3
complete
8-9 Years 13.6 16.5 14 16.5 14.3 15.7 15.2 13.8 14.8 15 14.4 14.8
complete
10-11 5.9 12.5 6.6 9.9 14.3 11.6 5.7 10 7 7 12.5 8.5
Years
complete
12 or more 6.6 19 8.2 9.9 21.1 14 7.1 19.3 10.5 7.8 20.2 11
years
complete
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Total # of 4469 594 5063 3372 2014 5386 3639 1493 5132 11480 4101 15581
members
26
NIPI Baseline Report – Orissa
As expected, illiteracy was consistently higher in the rural areas of all three Districts as against
their urban counterpart. Overall, 32% of the members of the rural sample households had no
formal schooling while this was much lower in the urban areas (19.9%).
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.
As expected, the majority of the houses in rural areas were of 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 Jharsuguda and urban
Sambalpur, where over a third of the sample lived in such houses.
As per DLHS 3, about 64% people were living in Kaccha houses while NIPI survey reports a
slightly less percentage (58%) of people living in kaccha houses. It may be safely concluded that
the sample drawn from across the three Districts was not affluent in nature.
27
NIPI Baseline Report – Orissa
Majority of the households depended on tube wells for …I spent „untied funds‟ of NRHM
their drinking water in rural areas, especially in program…we built and repaired
Jharsuguda and Sambalpur. However, a fairly large
roads…built toilets…dug
segment living in rural Angul actually sourced their
tubewells… - Muralidhar Churia,
drinking water from unprotected wells (33%), which is an
Sarpanch Village Charpalli, Block
area of concern. Overall, 21% of the rural sample drew Dhankuda, Sambalpur
drinking water from this source. In urban areas, more
options were available and it was observed that people
had access to piped water at home, within residential compound or from a public tap. The piped
water facility seems to be most developed in Angul District, followed by Sambalpur. It has yet to
be made available in a significant way in Jharsuguda.
District
Orissa
Angul Jharsuguda Sambalpur
Rur Urba Tota Rura Urba Tota Rura Urban T Rur Urban T
al n l l n l l ot al ot
al al
% % % % % % % % % % % %
Use Electronic 0.7 15.2 2.3 1.9 5. 3.1 0.9 6. 2.4 1.1 7. 2.6
Purifier 5 3 2
Let it Stand and 0.2 0.7 0.2 1. 0.4 0.2 0. 0.4 0.1 1. 0.3
Settle 1 8 0
Other 0.1 0.1 0.1 0.1 0.2 0.2 0.1 0.1
Do not treat/filter 79.5 60.1 77.3 74.1 43 63.5 81.9 59 75.6 78.8 52 72.1
.9 .7 .4
Total 100. 100.0 100.0 100. 10 100.0 100. 10 100. 100.0 10 100.
0 0 0. 0 0. 0 0. 0
0 0 0
Total No. of HH 1070 138 1208 804 43 1239 927 36 1294 2801 94 3741
5 7 0
* Multiple response questions
28
NIPI Baseline Report – Orissa
The usual method of storage of drinking water was …last two years NRHM „untied funds‟
in a covered vessel (bucket or earthen pot). This have been well spent…all roads have
was consistent across all three Districts. Correct been repaired…all facilities of drinking
storage practice was observed to be relatively water have been augmented…new
higher in urban areas than rural. sources of drinking water found… -
Surya Kanti Sethy, Woman Sarpanch,
The most common filtration/purification process Village Badmal, Block Redhakhol,
was boiling, whether it is urban or rural locations. Sambalpur
In urban areas of Jharsuguda and Sambalpur,
there is a practice of using filters (ceramic/sand/composite), but not so in Angul, where the
greater acceptability was that of electronic purifiers.
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 (75-80%) as compared to urban households (45-60%).
29
NIPI Baseline Report – Orissa
Firewood was the most commonly used cooking fuel across the rural areas of all three Districts
while in the urban areas, it appears to be a mixture of coal (32.6%), wood (29%) and electric
stove (21.7%) in Angul District, coal (41%), wood and LPG (20% each) in Jharsuguda, and coal
(41.7%), LPG (22.3%) and electricity (20%) in Sambalpur.
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 rural locations. The same was around 70% in the urban households, implying
that in the rural households, the inhabitants were at a higher risk of suffocation resulting from the
cooking smoke than from the urban households.
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.
District
Orissa
Angul Jharsuguda Sambalpur
Rura Urba Tota Rura Urba Tota Rura Urba Tota Rura Urba Tota
l n l l n l l n l l n l
% % % % % % % % % % % %
House owned or rented
Own 97.8 64.5 94.0 89.8 56.6 78.1 96.0 64.6 87.1 94.9 60.9 86.3
30
NIPI Baseline Report – Orissa
Rented 2.2 35.5 6.0 10.2 43.4 21.9 4.0 35.4 12.9 5.1 39.1 13.7
Ownership of Agricultural land
Yes 55 38 53 55 44 51 51 24 43 54 35 49
No 45 62 47 45 56 49 49 76 57 46 65 51
Total 100. 100.0 100. 100. 100.0 100. 100. 100.0 100. 100. 100.0 100.
0 0 0 0 0 0 0 0
Total No. of 1070 138 1208 804 435 1239 927 367 1294 2801 940 3741
HH
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 40% people did live on
rent. The trends are very similar across Angul and Sambalpur, with Jharsuguda having more
people staying on rent than the rest.
In the rural areas of all three Districts, cultivation …last two years particularly there has
accounted for the main income source for not been improvement in condition of
more than a quarter of the households. This people…health situation also
observation is very much in line with many improving…after NREGP financial
economic surveys which show a clear trend in status of people increasing…number
decline in the earnings from agriculture and the of educated people also increasing… -
need for large scale supplementation from either Lambodar Pradhan, Sarpanch, Village
local level labour activities or migration in search Dangarpara, Block Jujumana, Sambalpur
of jobs to other states.
The situation is similar here as well. Next to farming, 35.6% of rural households had reported that
their main source of livelihood was agriculture labour and other labour activities, and if one
considers most jobs in the construction industry would be un-skilled daily waged, the proportion is
even higher. Like the rest of India, only around 10% 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 40%). There were some labour activities as well, including
those in the construction sector. Around 10% of the households were into business.
Household level asset ownership, instead of being investigated at an individual asset level, has
been taken together to construct a household wealth index (HWI). We have considered the data
records of all the households in the state. The selected assets/ indicators for the construction of
index were: ( Annexure A1)
31
NIPI Baseline Report – Orissa
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 of 1, otherwise it is given a 0 score.
b) Fuel used for cooking – If a household is using modern forms of fuel for cooking
purposes (electricity, LPG, biogas and kerosene) then the household is awarded a score
of 1, otherwise it is given a 0 score.
The next 24 indicators were considered directly from the ownership. If a household owned one
particular asset, then it was given a score of 1 for that asset, otherwise 0. This procedure first
standardized the indicator variables (calculating z-scores); then the factor coefficient scores
(factor loadings) were calculated; and finally, for each household, the indicator values were
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 5 variables due to their low or negative effect on index. Based
on the remaining 21 variables, in the Principal Component Analysis the components with Eigen
values greater than 1 were explaining a variation of around 60.9% in the data, with the first
component explaining 35.9% of variation.
32
NIPI Baseline Report – Orissa
The proportion of households belonging to each quintile, across urban and rural areas of the
three Districts is as follows:
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 (45-65%) while it was more or less
the reverse in the urban areas (with 35-40% in the highest quintile). In line with what we had
observed regarding the poverty rate, here too the households of Jharsuguda appeared to be
more affluent than either Angul or Sambalpur.
In India, the overall banking penetration as on 2007 was 44%. The situation in the study Districts
was even worse with only 33% of households had any member with a bank account. Bank
penetration was relatively higher in Jharsuguda District as compared to the others.
33
NIPI Baseline Report – Orissa
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 for factory
workers and public sector employees. (AnnexureA2)
Details regarding funds allocated and utilised for different activities under NRHM are presented.
Till December 2007, in Angul, about four fifth of the money disbursed to them was spent, while in
Sambalpur about half of the funds allocated were utilised. Thus complete utilisation of the funds
allocated or received is an area that needs attention.
The fund utilization status for different activities in Angul District shows that all the allocated
money was spent for setting up infrastructure in the District Programme Management Unit
(DPMU), while only 7 percent was spent on training of programme managers. About three fourth
of the amount allocated for immunisation was spent indicating partial utilisation of the allocated
funds.
The fund utilization in Sambalpur District (till December 2007) shows about half of the amount
allocated for different heads under IMNCI training was spent. In case of immunisation, about two
third of the amount allocated for the financial year was spent till December 2007.
Fund utilization in Jharsuguda (Annexure 21) shows that about two third of the funds allocated for
immunization was spent, while more than four fifth of the fund allocated for JSY was utilized.
Summary observation
34
NIPI Baseline Report – Orissa
35
NIPI Baseline Report – Orissa
Chapter 3
Characteristics of Survey Respondents
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.
District
Total
Angul Jharsuguda Sambalpur
Age Group % % % %
15-18 3.5 0.6 1.9 2.0
19-21 22.3 15.7 17.7 18.5
22-25 38.5 42.0 42.3 41.0
26-30 26.0 30.4 26.4 27.6
31-40 9.1 11.0 11.2 10.5
41-49 0.6 0.3 0.5 0.4
Number of women 1,161 1,186 1,176 3,523
65-70% of the interviewed women were in the age bracket of 22 – 30 years. Very few (2%) were
actually at or below the legal age of marriage. Only around 10% of the sample consisted of
currently married women aged above 30 years.
District
Total
Angul Jharsuguda Sambalpur
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 0.5 1.5 0.7
Other 0.1 0.0
Caste/tribe
Schedule Caste 24.6 17.8 23.1 21.8
Schedule Tribe 19.4 30.4 35.1 28.3
OBC 40.3 37.3 29.7 35.8
General caste 15.7 14.5 12.1 14.1
Number of women 1,161 1,186 1,176 3,523
The eligible women interviewed were almost entirely of Hindu faith. They were mostly from OBC
families (35.8%) or STs (28.3%). Around a fifth was SCs and the minority in this case was
general castes.
36
NIPI Baseline Report – Orissa
District
Total
Angul Jharsuguda Sambalpur
Education (Years of Schooling) % % % %
No education 40.1 24.5 34.8 33.1
<5 7.2 8.5 9.5 8.4
5-7 16.8 18.6 18.4 17.9
8-9 19.6 19.1 17.1 18.6
10-11 8.5 13.4 9.5 10.5
12 & Above 7.8 15.9 10.7 11.5
Number of women 1,161 1,186 1,176 3,523
Female literacy was highest in Jharsuguda (75.5%) and lowest in Angul (60%). However, it must
be said that these percentages are far above the all India average. Majority of the women in our
th
survey sample seem to have educated beyond primary level (5 grade) but not completed
th
secondary education (10 grade). Around 30% of the sample in Jharsuguda had received at least
10 years of formal education while this was 20% in case of Sambalpur and around 16% for Angul
District. The District wise relationship between education and age of respondent has been
provided in Annexure Table A1.
The husbands were far more educated than their spouses with average literacy being 77.8%
(both read and write).
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.
Overall, only 26% of the women who were literate read a 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 15% women listening to the radio regularly. This is very much in
line with the NRS 2006 findings.
On the other hand, television viewer ship enjoys by far the largest penetration among the women
respondents with 58% women reporting that they watch television regularly. This is as high as
84% in urban areas and nearly 50% 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
37
NIPI Baseline Report – Orissa
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.
We had already seen that even among literates, the practice of reading a newspaper or magazine
was limited with 73.6% claiming not to be doing so.
Radio listenership was again rather infrequent with 85.2% stating they do not listen to the radio at
all. Only television viewers seem to be accessing this medium with the degree of regularity
(43.5% watch almost every day) required for making this a viable alternative channel for
communicating key health messages. (Annexure 4, 5, 6)
Out of the 1161 interviewed women in Angul District, only 245 (or 21%) had any independent
source of income. In line with the age distribution of the sample in Angul District, most of these
women were between 22 – 30 years of age (62%).
Similarly, out of the 1176 interviewed women in Jharsuguda District, only 141 (or 12%) had any
independent source of income. In line with the age distribution of the sample in Jharsuguda
District, most of these women were between 22 – 30 years of age (77%).
Finally, out of the 1186 interviewed women in Sambalpur District, 347 (or 29%) had any
independent source of income. In line with the age distribution of the sample in Sambalpur
District, most of these women were between 22 – 30 years of age (68%).
38
NIPI Baseline Report – Orissa
The second part of this table needs to be interpreted in conjunction with Table 3.3. It may be
recalled that overall, 33% of the responding women were illiterate. However, these 33%
accounted for 53% of the total number of earning women in the sample. Again, 22% of the
th
sampled women were educated till their 10 standard and beyond. But, this relatively highly
qualified segment contributed to only 10.3% of the total earning women in the sample. This
analysis clearly implied that in Districts of Orissa, 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)
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.
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
NIPI Baseline Report – Orissa
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 Orissa stands between 15-18 years.
40
NIPI Baseline Report – Orissa
District Total
Angul Jharsuguda Sambalpur N %
Age At Cohabitation (in Years) N % N % N %
15-18 652 56.2 478 40.3 535 45.5 1,665 47.3
19-21 361 31.1 455 38.4 437 37.2 1,253 35.6
22-25 119 10.2 214 18.0 166 14.1 499 14.2
26-30 27 2.3 36 3.0 34 2.9 97 2.8
31-40 2 0.2 3 0.3 4 0.3 9 0.1
Total 1,161 100 1,186 100 1,176 100 3,523 100
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 Angul (56%) 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
Rural Urban Total
N Mean Median N Mean Median N Mean Median
Education No schooling 963 18.3 18.0 202 18.2 18.0 1,165 18.2 18.0
of
<5 244 18.4 18.0 53 18.2 18.0 297 18.3 18.0
respondent
5-7 500 19.0 19.0 132 18.6 18.0 632 18.9 18.0
8-9 496 19.2 19.0 159 18.7 18.0 655 19.1 19.0
10-11 237 19.9 20.0 133 19.9 20.0 370 19.9 20.0
12 & above 195 21.6 21.0 209 22.5 22.0 404 22.1 22.0
Household Lowest 1,543 18.4 18.0 166 18.4 18.0 1,709 18.4 18.0
Wealth
Second 354 19.4 19.0 138 18.3 18.0 492 19.1 19.0
Index
Middle 305 19.7 19.0 107 18.8 18.0 412 19.4 19.0
Fourth 218 19.9 20.0 139 19.4 19.0 357 19.7 20.0
Highest 215 20.6 20.0 338 21.1 20.0 553 20.9 20.0
Total 2,635 19.0 19.0 888 19.6 19.0 3,523 19.1 19.0
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 18 years while that of those
th
educated beyond the 10 standard was 20 – 22 years. Similarly, women belonging to a higher
economic profile married/cohabited 2 years later than those who were illiterate (18 years).
41
NIPI Baseline Report – Orissa
Chapter 4
Maternal Health
4.1 Preamble
Maternal health care is a concept that encompasses family planning, preconception, prenatal,
and postnatal care. Goals of preconception care can include providing education, health
promotion, screening and interventions for women of reproductive age to reduce risk factors that
might affect future pregnancies. Antenatal care is the comprehensive care that women receive
and provide for themselves throughout their pregnancy. Women who begin prenatal care early in
their pregnancies have better birth outcomes than women who receive little or no care during
their pregnancies. Postnatal care issues include recovery from childbirth, concerns about
newborn care, nutrition, breastfeeding, and family planning.
Antenatal care or ANC is the care of a pregnant woman during the time in the maternity cycle that
begins with conception and ends with the onset of labor. 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, and awareness of pregnancy complications by mothers
and health problems and treatment seeking behaviour during last pregnancy.
Table 4.1: Percentage of pregnancies registered vs. key background variables, NIPI-08
Overall, 91.6% of the pregnancies in Angul Districts were registered, while this was as high as
99% in Jharsuguda District and 97.1% in Sambalpur. Of the total registered pregnancies, about
92 percent were registered with government health facilities while the rest 8 percent registered
with private health institutions.
42
NIPI Baseline Report – Orissa
100
5.4
7.2 7.8
10.6
Percent
90
92.8 94.6
92.2
89.4
80
Angul Jharsuguda Sambalpur ORISSA
Private facility Government facility
Most of the last pregnancies which occurred among women aged 19-30 years were registered
across all three Districts but it may be interesting to note that there was a sharp drop in
pregnancy registration among older women as well as those who became pregnant at a very
young age, probably more so if there age was below the legal limit for marriage.
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.
94.4% of the interviewed women had claimed that they had an ANC card while this could be
physically verified for only 80.5% of them. Availability of the ANC card was lowest in Angul District
and much higher (98%) in the other two Districts.
43
NIPI Baseline Report – Orissa
Across all the three Districts, the most frequented source of ANC was the government/municipal
hospital, followed by the local PHC. Private hospitals/clinics were also a significant source
(18.1%), especially in Jharsuguda. This was followed by local consultation in the form of AWW.
Among those 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 government
doctor (61.6%). This was followed by the ANM/burse/midwife/LHV (nearly 30%), private doctors
(21.6%) and a similar share being contributed by the ASHA and the AAW (14%). The trend was
very similar across all three Districts.
There was found a case for conflict of interest and overlapping of effort and time spent between
ASHA, ANM and AWW.
…ASHA help me in home visit…I give
medicines to her to give to villagers…I
In respondent reports it was gathered that
rectify her work…I shall give suggestion
ANM was the ‗outsider‘ service provider that we two must always work
visiting once in a while and ―locally‖ available together…ASHA listen to me and learn
service providers, particularly the AWW and from me… - Bilasini Nayak, ANM, Village
the ASHA, in particular were carrying out the
Banharpuli, Block Lakhanpur, Jharsuguda
NRHM work.
44
NIPI Baseline Report – Orissa
In a District like Jharsuguda, the ANM considered ASHA as ‗junior‘ partner and the local person
to carry out her ―instructions‖.
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.
Antenatal care indicators show a better picture in Orissa compared to all India, though the figures
are still low. About three fifth of the pregnant women had at least three antenatal checkups during
their last pregnancy.
Figure 4.1a: Percent of Mothers who received three or more antenatal checkups
60.9
70
51
60 48
44 44
50 34.9
40
30
20
10
0
NFHS-1 NFHS-2 NFHS-3
Orissa India
As per DLHS-3, in Jharsuguda (65.8%) and Sambalpur (67.4%) districts, nearly two-third of the
pregnant women had at least 3 antenatal care visits during their last pregnancy as against Angul
district, where the corresponding figure was 60 percent.
Table 4.6: Number of ANC received and timing of ANCs received, NIPI-08
45
NIPI Baseline Report – Orissa
NIPI-08 baseline survey clearly reveals that more than 80 percent of the pregnant women had at
least 3 antenatal checkups during their last pregnancy (85 percent and 81 percent) in Jharsuguda
and Sambalpur districts while in Angul District, only 62 percent women reported the same.
Subsequently in NIPI Phase II survey, most of the women who had gone in for ANC during their
last pregnancy had received 2 or more ANC checkups. Consistently across all Districts, the
propensity to get more ANC checkups was more in urban areas than in the rural areas. Nearly all
th
the women had received their first ANC within the 5 month of their pregnancy. Around 50% had
received it within their first trimester itself. The findings are consistent across all three Districts.
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: Percent of Mothers who consumed IFA for 90 days and Received 2 or more TT during
Pregnancy
Orissa India
83.3
90 76.3
80
70
60
50 33.8 23.1
40
30
20
10
0
Consumed IFA for 90 Received 2 or more TT
days injections
46
NIPI Baseline Report – Orissa
Consumption of IFA continuously for 90 days is considered vital for the survival of mothers and
children, but the figures for Orissa are very low (though better than India). More women (83.3%)
in Orissa received 2 or more TT injections during pregnancy as compared to all India (76.3%) at
the time of NFHS-3 (2005-06).
According to DLHS-3, 98% women received at least one TT injection during last pregnancy in
Sambalpur followed by Jharsuguda (97%) and Angul (91%). It is interesting to note that the
percentage of women received at least one TT injection is higher in rural areas (99%) of
Jharsuguda in comparison to total district‘s coverage while in the other two districts, rural
coverage is lower than total coverage of women received one TT injection.
Table 4.7: Proportion of eligible women having received different components of ANC care, NIPI-08
Table 4.7 shows that the incidence of women having received at least 2 TT injections is almost
double that of those who told IFA tablets for at least 90 days. This situation is consistent across
all three Districts.
The above table provides details of the nature of ANC received by the pregnant mothers during
their last pregnancy. It may be noted that the most common ANC components received were
measurement of weight and abdomen examination. Nearly a similar number had received advice
on care during pregnancy period. Consistently, …the village can improve if both ASHA
more women in the urban areas had received and ANM can work amicably together…
different components of ANC than their rural - Swalo nag, ANM, Village Baghmunda,
counterparts. Across all three Districts, the Block, Lakhanpur, Jharsuguda
features those were conspicuous by their
47
NIPI Baseline Report – Orissa
absence advice on new born care, family planning advice, etc. Surprisingly, only 44% in rural
areas and 67% in the urban areas had reported that they had not receive any advice on danger
signs during pregnancy.
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 HMIS information is collected at the grassroots by ANM. She sends the report to PHC level.
From PHCs data is sent to Block.At the block level the data is compiled and data sheet is
prepared to be sent to District HQ
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.
48
NIPI Baseline Report – Orissa
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 behaviour.
49
NIPI Baseline Report – Orissa
Most of the women seemed to have been aware …I am taking care of more than 7000
of swelling of hands and feet as a tangible population…women are going to
pregnancy complication, perhaps because they hospital for delivery…they are quite
would have experienced t first hand. Apart from aware after ASHA intervention… -
this, no more than a fifth of the respondents Rukmani Sahoo, ANM, Village
were actually aware of any other symptom. 16% Dangarpara, Block Jujumra, Sambalpur
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 (38%)
and from health personnel at service locations where they had gone in for ANC (27%).
ANM problems related to location, transport and reach affecting impact and program
design issues
Respondents opined that since now there was high degree of institutional delivery and IMR-
MMR was going down allied with high degree of awareness generation
Respondents said that they had to cover large areas and huge populations
In rural areas there was certain variation th
…I am 12 pass…have 19 years
in functioning of ANM as per their experience…I am living in Sambalpur, not in
location sub-centre village…I go by bus…takes me
ANM situated in the sub-centre village 45 minutes…seven villages under me with
ANM situated in the block 5000 population – Minakhi Pujhari, ANM,
ANM not in sub-centre village Block Bangan, Sambalpur
ANM situated in remote village reporting
to block or sub-centre
30% of the women in our sample had experienced some sort of health problems during their last
pregnancy. In the Districts of Jharsuguda and Sambalpur, more urban women faced problems
than their rural counterparts but the situation was reverse in Angul District. The incidence of
health problems during pregnancy was more pronounced in Sambalpur District (40%) than the
others.
50
NIPI Baseline Report – Orissa
Table 4.12: Nature of health problems faced during last pregnancy, NIPI-08
District
All Districts
Angul Jharsuguda Sambalpur
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Tota
l
% % % % % % % % % % % %
Swelling of 58.1 70.8 59.0 32.6 47.0 39.6 44.0 39.9 42.6 47.3 45.3 46.7
hands & feet
Paleness 2.1 1.9 2.1 1.5 1.8 12.3 13.3 12.6 6.3 7.3 6.6
Visual 14.4 12.5 14.3 5.6 2.2 4.0 13.6 10.1 12.4 12.4 7.0 10.8
disturbances
Excessive 10.7 8.3 10.5 5.6 4.5 5.0 5.8 4.4 5.4 7.7 4.7 6.8
bleeding
Convulsions 12.7 12.5 12.7 2.1 7.5 4.7 13.3 12.0 12.8 10.9 10.1 10.7
Abnormal 2.7 12.5 3.5 0.7 5.2 2.9 4.5 3.8 4.3 3.1 5.1 3.7
position of
foetus
Weak or no 6.5 16.7 7.3 13.2 8.2 10.8 15.5 19.0 16.7 11.6 14.2 12.4
movement of
foetus
Total 291 24 315 144 134 278 309 158 467 744 316 1060
As mentioned earlier, the relatively higher awareness of swelling of hands and feet could be
result of having experienced this complication first-hand, the above table validates this
assumption. Apart from this, awareness and experience regarding other symptoms were
observed to be quite low.
Table 4.13: Percentage of women who sought advice for heath problem during pregnancy, NIPI-08
Angul Jharsuguda Sambalpur All Districts
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
Yes 72.5 87.5 73.7 84.7 81.3 83.1 85.4 90.5 87.2 80.2 86.4 82.1
No 27.5 12.5 26.3 15.3 18.7 16.9 14.6 9.5 12.8 19.8 13.6 17.9
Total # of women 291 24 315 144 134 278 309 158 467 744 316 1060
Of all the 1061 women who had reported to have faced any complications during pregnancy, a
little over 80% had consulted someone regarding their problem. The usual places of consultation
…in the village there are no facilities for had been government/municipal hospital (45%),
weak children and new born babies… - followed by private hospital/clinic (39%) in urban
Padmini Mehar, ASHA, ward no.18, Block areas and government hospital (28%), private
Lakhanpur, Jharsuguda hospital/clinic (23%) and PHC/CHC (22%) in
case of rural areas.
Overwhelmingly (92%), it was the doctor who was the health personnel consulted when the
pregnant women went to a facility for a checkup for complications.
51
NIPI Baseline Report – Orissa
Overwhelmingly, it was the husband (65%) who had …I feel sorrow for ASHA
persuaded the woman to go in for treatment of complication …she is doing so much
experienced during the pregnancy period. This is fairly work…she should be given
consistent across all three Districts and it is also consistent salary, cycle and mobile…
that the role of (she can be made an ANM)…
… Government has banned filling up the husband - Manju Dash, ANM, Village
of vacant positions. Only ASHA posts was more Haldipali, Block Kuchinda,
are completely filled up in this district. pronounced in Sambalpur
One person has to cover up big urban
territory, which results in deterioration households than the rural households. The role of
of quality in service delivery. the ANM and ASHA seems to have been relatively
Adequate manpower is needed limited except for the District of Sambalpur where
…CMHO, Sambalpur, Angul they did seem to have played a role with around
15-25% of the pregnant women.
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/still birth
during two years preceding the survey, we had asked the women place of delivery, who 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.
60.0
46.4 48.3
50.0 40.7 42.4
38.7
40.0 33.4 33.6 33.0
30.0 26.1
22.6
19.0
20.0 14.1
10.0
0.0
NFHS-3 NFHS-2 NFHS-1 NFHS-3 NFHS-2 NFHS-1
Orissa India
According to NFHS, trend reports the percentage of women delivered in health facility has
steadily increased in both all India and Orissa. In Orissa, institutional deliveries were only 14% in
1992-93 (NFHS1), which has become almost three fold to 39% in 2005-06 (NFHS3). Assistance
of trained health personnel during delivery is critical in maternal and child survival. A steady
increase was also noted in the number of pregnancies assisted by health personnel in both
Orissa and India. When compared to all India, Orissa is still lagging behind in terms of both
institutional delivery and births assisted by health
personnel. (Figure 6.4) …in the last two years ASHAs have
started maintaining records…do
At juxtaposed a recent DLHS-3 reported institutional home visits…I also sometimes
deliveries at 44.3% while NIPI Phase II survey also accompany her…women now go to
clearly indicates that the trend has increased to her…she takes them to hospital for
nearly 58% of all deliveries, which took place in delivery… - Surekha Sahoo, AWW,
government hospitals (73.5% in institutions), while Village Bandha bahal, Block lakhanpur,
only 26% took place at home. Jharsuguda
52
NIPI Baseline Report – Orissa
53
NIPI Baseline Report – Orissa
65
70 58
60 54 54
50
Percent
40 35
30 22 24 22 26
20 13 16
11
10
0
Angul Jharsuguda Sambalpur ORISSA
As per the NIPI-08 baseline, Sambalpur district showing a highest percentage (78%) of
institutional deliveries (government + private) followed by Jharsuguda (76%) and Angul (65%).
Data reveals that in Sambalpur, more number of women (65%) is going for institutional deliveries
in government hospitals in comparison to other two districts whereas in Jharsuguda percentage
of institutional deliveries in private hospitals (22%) is highest among three NIPI districts.
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.
The trend in the data clearly indicates that the younger generation preferred to have their
deliveries in an institution while the older women preferred to have their deliveries at home. One
of the explanations for such a trend was that while 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.
54
NIPI Baseline Report – Orissa
The preference for institutional deliveries is strong among all women irrespective of her literacy
level. However, with literacy, the
…maximum deliveries now in hospital…this is propensity to deliver at home comes
due to JSY…but some mothers still fear to go to down quite drastically (from 45.7% for
hospital…some do not find transport…main illiterate women to 9% or lower for
reason is Rs.1400/- given to mother…no delivery those who have passed their 10
th
1-2 1628 62.1 501 19.1 311 11.9 167 6.37 5 0.53 2621 100
3-4 341 47.8 47 6.6 220 30.9 102 14.3 2 0.4 713 100
5+ 66 34.9 4 2.1 73 38.6 44 23.3 2 1.1 189 100
Total 2035 57.8 552 15.7 604 17.1 313 8.88 9 0.26 3523 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 81% for women with 1-2 live children to 52% for those who had more than 2.
Table 4.18: Place of delivery v/s economic status of respondents‟ household, NIPI-08
Institutional Home Total
Wealth Govt Hospital Private In-laws Parental Other All Births
Index places
N % N % N % N % N % N %
Lowest 970 56.8 63 3.7 425 24.9 244 14.3 4 0.3 1709 100
Second 338 68.7 49 10.0 76 15.4 27 5.5 2 0.4 492 100
Middle 292 70.9 49 11.9 51 12.4 17 4.1 2 0.7 412 100
Fourth 209 58.5 101 28.3 33 9.3 14 3.9 357 100
Highest 226 40.9 290 52.4 19 3.4 11 2.4 1 0.9 553 100
Total 2035 57.8 552 15.7 604 17.1 313 8.9 9 0.3 3523 100
55
NIPI Baseline Report – Orissa
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.
Family members, usually the husband, had the responsibility of arranging the transport for taking
the pregnant woman to the health institution.
DISTRICT
Total
Angul Jharsuguda Sambalpur
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban 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 Jharsuguda and Sambalpur
Districts which range from as high as Rs.600 in Jharsuguda rural to as low as Rs.130 in
Sambalpur urban. The differences are far more modest in Angul District. The cost of
transportation was in general highest in Jharsuguda (Rs.500) and lowest in Angul (Rs.350).
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 15% of the deliveries across both urban and rural areas were assisted deliveries.
56
NIPI Baseline Report – Orissa
1
Table 4.21: Cost incurred in institutional delivery , NIPI-08
The average (or mean) cost …now people are more aware…they go for hospital
incurred on institutional deliveries delivery…yes there are problems…yes doctors are
came to around Rs.3921, while the begging for money… - Kumari Pradhan, Block
median value was Rs.2000. The Chendipada, Angul
differences between urban and rural
areas were quite pronounced across all the Districts even though the median value was exactly
the same. The biggest difference in rural and urban costs was observed in Angul District where
the difference is nearly Rs.2000.
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 22 25.6 11 12.8 20 23.3 30 34.9 3 3.5 0 86 100.0
19-21 157 23.8 59 9.0 171 25.9 221 33.5 41 6.2 10 1.6 659 100.0
22-25 331 24.8 122 9.2 305 22.9 489 36.7 64 4.8 22 1.6 1333 100.0
26-30 207 25.7 81 10.0 190 23.5 277 34.3 40 5 12 1.5 807 100.0
31-40 66 25.5 26 10.0 48 18.5 102 39.4 11 4.2 6 2.4 259 100.0
41-49 1 33.3 1 33.3 1 33.4 3 100.0
1
Government Hospital
57
NIPI Baseline Report – Orissa
Advice Jharsuguda
Doctor Nurse Ward ANM Others Total
attendant
% % % % % %
New born care practices 71.3 21.6 0.5 4.4 2.3 100.0
Breast Feeding 70.1 25.0 0.5 4.1 2.4 100.0
Immunization 71.1 34.0 0.3 5.0 1.8 100.0
Routine check up 78.4 19.0 0.3 2.7 1.4 100.0
Spacing method 69.1 70.0 1.2 3.9 2.7 100.0
Any other advice 50.0 21.0 100.0
Advice Sambalpur
Total
Doctor Nurse ANM Others
% % % % %
New born care practices 75.7 20.7 2.6 1.0 100.0
Breast Feeding 74.2 57.0 2.7 1.0 100.0
Immunization 75.7 75.0 2.7 1.0 100.0
Routine check up 79.4 20.0 1.7 0.3 100.0
Spacing method 81.8 2.9 1.4 100.0
Any other advice 60 1.0 10 100.0
75-80% of the respondents had confirmed that they had received advice post delivery of their
child and the nature of advice included newborn care practices, breast feeding, immunization,
routine checkup and spacing methods to be adopted to delay the next child. It was mostly the
resident doctor who imparted the advice. The only exception was that nurses in Sambalpur
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
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
58
NIPI Baseline Report – Orissa
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).
The mothers in Sambalpur by and large were more satisfied than those from Angul and
Jharsuguda.
59
NIPI Baseline Report – Orissa
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.
1. Paracetamol
2. ORSS … We are conducting 2-3 days training
3. Chloroquine programme for ASHAs all over the District for
4. Betadine their capacity building. For Medical Officer
5. Surgical gauze regular up gradation training happens. Also
6. Cotton LHV/ SBA training, immunization training
7. Oral contraceptive pill and training for Nursing staff take place
8. Vitamin A continuously…..DMHO Sambalpur
9. Leprosy tablet
The contents and nature of the medicine box varied over area. The places near to block or
District town had better equipped ASHA medicine box, since they were replenished regularly
as per the accounts given by respondents themselves.
Respondents also provided First Aid to children and infants
Village health days were not found to be …ANM madam is inspecting my work
regular in most places whether I am working properly or not…I
ANM and Community Leaders give my report to ANM madam…she
sometimes called for meetings attended analyse my report and tell me if there is
by ASHA any mistake in my work… - Bhanumati
Respondents could not narrate Boi, ASHA, Village Pandiripather, Block
definitively about any village level health Jharsuguda.
plan
Under NRHM, ASHA‘s have been appointed in almost every village of the country. Main purpose
of their appointment is to provide basic advice or help households in relation to ante natal, natal
and post natal care, newborn care, immunization and family planning. In order to have a proper
understanding of all these aspects, five training modules have been designed for them and every
ASHA is supposed to get training in all these modules. As per the data provided by DPMU, about
78 percent ASHA‘s received training in Module-1 in Angul district followed by Smbalpur (67.9%)
60
NIPI Baseline Report – Orissa
and Jharsuguda (52.9%). In Module-2, nearly one-third ASHA‘s are trained in Smbalpur while in
case of other 2 NIPI districts, a little over one-fifth ASHA‘s are trained.
All Districts
Rural Urban Total
N % N % N %
Did the ASHA accompany you?
Yes 1184 63.7 238 32.6 1422 55.0
No 604 32.5 399 54.7 1003 38.8
NA 70 3.8 92 12.7 162 6.2
Total 1858 100.0 729 100.0 2587 100.0
If no, did she reach later on?
Yes 128 21.2 49 12.3 177 17.6
No 476 78.8 350 87.7 826 82.4
Total N 604 100.0 399 100.0 1003 100.0
Why did ASHA not accompany you?
1) We did not 277 58.2 258 73.7 535 64.8
inform her
2) We informed 59 12.4 30 8.6 89 10.8
but she refused
to come along
3) She was not 79 16.6 36 10.3 115 13.9
present in the
village
4) Don't Know 30 6.3 11 3.1 41 5.0
5) Any Other 31 6.5 15 4.3 46 5.5
Total N 476 100 350 100.0 826 100.0
In 55% of the cases the ASHA had accompanied the …ASHA take pregnant women to
pregnant women to the hospital. In 17.6% of the case, medical centre…do
she had arrived later on. This essentially implies that in delivery…ANM „didi‟ do
72.6% of the cases, the pregnant women were attended immunization…help in health
by the ASHA in the institution. meeting, mothers‟ meeting and
home visit… - Gauri Dohuri,
However, it may also be noted that the absence of the AWW, Ward no. 6, Jharsuguda
ASHA was not really her conscious choice as in most
cases (64.8%), she was not informed that the patient was being taken to the facility. In less than
25% of the cases was she not present in the village at that time or she refused to accompany the
pregnant woman.
61
NIPI Baseline Report – Orissa
Table 4.28: Duration of stay of the mother at health facility after delivery
Most of the women in Angul District seem to have stayed in the health facility for a period of less
than 6 hours. For those who stayed longer, it was either for a day or two, or stayed for a long
stretch of time due to various complications. This phenomenon is true for both urban and rural
areas of the District.
For the other two Districts, the average duration of stay post delivery seems to have been 1-2
days in Jharsuguda and 1-6 (32%) days in Sambalpur (64%).
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 actual 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.
62
NIPI Baseline Report – Orissa
The trends across the three Districts were similar except for the fact that the cost issue was a
major determinant in Angul rural.
Situating JSY in its Socio-Economic context (as narrated by health service providers,
community leaders and local officials)
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.
63
NIPI Baseline Report – Orissa
Data reveals that only one out of four home deliveries occurring on the ground (24.3%) with clean
clothes/plastic underneath. Nearly similar proportion of home deliveries are also conducted on the
cot (26.7%) with clean clothes/plastic. But a significant proportion (40.7%) of deliveries taken
place on the ground without any cloth/plastic which is a matter of serious concern. Jharsuguda
practicing relatively better home delivery practices followed by Sambalpur and Angul.
As shown in the table 4.29 about home delivery practices, this has clearly come out from the data
that women from rural locations, with no education and lowest wealth index, did not follow the
standard precautionary measures during the delivery.
64
NIPI Baseline Report – Orissa
Delivery District
All NIPI Districts
Specification Angul Jharsuguda Sambalpur
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
Person Conducted Delivery
Mid Wife/LHV 1.3 0.0 1.3 2.1 0.0 13.8 2.9 0.0 2.3 1.9 0.0 1.6
Trained Dai 2.9 0.0 2.8 12.7 15.9 0.3 17.6 21.7 18.4 9.3 14.9 10.3
Untrained Dai 5.9 0.0 5.5 20.6 28.0 0.0 19.0 4.3 16.4 13.1 16.2 13.6
ASHA 2.9 0.0 2.8 4.2 7.3 4.1 3.3 0.0 2.7 3.4 3.9 3.5
ANM 0.5 0.0 0.5 10.1 0.0 100.0 0.5 2.2 0.8 2.8 0.6 2.5
Family Member 63.0 76.9 63.9 25.4 15.9 28.3 35.7 32.6 35.2 46.4 31.2 43.8
Relatives/friends 25.5 30.8 25.8 10.6 14.6 0.7 13.8 23.9 15.6 18.7 20.1 18.9
Any Other 4.3 0.0 4.0 19.0 25.6 0.7 11.4 15.2 12.1 9.8 18.2 11.2
Total 373 26 399 189 82 271 8 46 256 772 154 926
Overwhelmingly in Angul District it was a family member/other relatives who performed the
delivery at home. This is across both urban and rural areas. The role of the dai (trained or
untrained) was observed to be minimal. On the other hand, in Jharsuguda and Sambalpur the
role of the Dai seems to have been as prominent as the family members with 25-35% of the
deliveries having been conducted by them in urban and rural areas respectively.
Table 4.32: Reasons behind choosing a specific person to conduct the delivery
Specification District
All NIPI Districts
Angul Jharsuguda Sambalpur
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
Why did you choose the person to conduct delivery
Past 42.6 50 43.1 34.9 30.5 35.3 27.6 41.3 30.1 36.7 37 36.7
Experience
Economical 10.2 7.7 10 4.8 6.1 4.9 1.9 2.2 2 6.6 5.2 6.4
Safe Delivery 25.2 34.6 25.8 38.1 42.7 38.6 61.4 41.3 57.8 38.2 40.9 38.7
Reliable 8.3 7.7 8.3 5.3 13.4 3.6 3.3 13 5.1 6.2 12.3 7.2
Behaviour of 6.7 0 6.3 0.5 2.4 4.5 1.4 0 1.2 3.8 1.3 3.3
the service
provider
Recommended 2.9 0 2.8 3.2 2.4 0.3 1 0 0.8 2.5 1.4 2.3
Others 4.1 0 3.7 13.2 2.5 12.8 3.4 2.2 3 6 1.9 5.4
Total 373 26 399 189 82 271 8 46 256 772 154 926
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.
65
NIPI Baseline Report – Orissa
rd
In nearly 2/3 of the instances of home deliveries, the person who had to make the delivery
happen was contacted before the labour pain had started. This was considerably higher in the
urban areas (75%) as compared to the rural areas (60%).
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.
rd
Once again, 2/3 of the women respondents who had home deliveries could recall that the
delivery attendant did wash his/her hand before undertaking the delivery but a quarter could
clearly recall that this was not the case. Soap and water was most often used for washing and the
majority confirmed this.
The average (or mean) cost incurred on institutional deliveries came to around Rs.3921, while the
median value was Rs.200. The differences between urban and rural areas were not quite
pronounced in any of the Districts.
66
NIPI Baseline Report – Orissa
In a little over a quarter of the cases, advice was not given immediately after delivery by the
attendants. 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.
Under this section, the responding women were tested 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.
Timings District
All NIPI Districts
of First Angul Jharsuguda Sambalpur
PNC Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
<4 Hrs 8.3 7.2 8.2 11.9 21.4 15.2 24.8 52.0 32.5 14.6 30.7 18.7
4-23 Hrs 0.8 0.7 0.7 0.5 0.6 3.2 9.0 4.8 1.5 3.6 2.0
1-2 days 1.0 2.2 1.1 2.5 1.0 2.0 7.7 9.6 8.2 3.6 4.4 3.8
3-41 4.0 4.3 4.1 6.6 2.7 7.2 2.4 5.9 5.8 2.8 5.1
days 5.2
>41 0.0 0.0 0.0 2.1 0.5 0.4 0.0 0.3 0.8 0.2 0.6
days 1.5
DK/CS 0.5 0.0 0.4 0.1 0.0 0.1 1.0 0.0 0.7 0.5 0.4
No 85.4 86.3 85.5 76.1 74.0 55.6 27.0 47.5 73.2 58.2 69.4
Checkup 75.3
Total 1020 139 1159 767 411 1178 939 333 1176 2630 883 3513
*NIPI survey 08
An overwhelming a similar trend in DLHS-3 and NIPI survey showed that nearly 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 Sambalpur urban, more than 50% had reported to
have had 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 Sambalpur. The situation in Angul 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 Jharsuguda was also bad with 75% reporting no PNC.
67
NIPI Baseline Report – Orissa
As given 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.
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 Angul (63% each) but quite a
difference in Jharsuguda District (96 - 73%). The roles of the ANM/nurse/midwife in providing
PNC seem to have been confined to the District of Angul alone.
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.
Maternal Mortality Ratio (MMR) in India stood at 301 per 1,00,000 live births, while the figure for
Orissa was 358 (Table 2.1c). The table shows that three surveys conducted between 1997 and
2003 show a declining trend in MMR in India whereas it is fluctuating in the case of Orissa.
2 3
Source Maternal Mortality Rate Maternal Mortality Ratio
India Orissa India Orissa
1997-1998 Retrospective MMR
34.8 29.7 398 346
Survey
1999-2001 SRS Prospective
31.2 36.7 327 424
Household Survey
2001-2003 Special Survey of
27.4 29.5 301 358
Deaths
Source: Maternal mortality in India: 1997-2003: Trends, causes and risk factors (2004): Registrar General of India, New
Delhi
2
Maternal mortality rate is defined as number of maternal deaths per 1,00,000 living women in the 15-49 years age group
3
Maternal mortality ratio is defined as number of maternal deaths per 1,00,000 live births to women in the 15-49 years
age group
68
NIPI Baseline Report – Orissa
Chapter 5
Newborn Care
5.1 Preamble
Care provided during the perinatal 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 on demand day and night; (b) Early
detection of problems or danger signs (with priority …I am higher secondary pass…I have
for sepsis and birth asphyxia) and appropriate been ANM for last 14 years…I am
referral and care-seeking. situated in my own village…my village
is also the one with sub-centre…I take
In this chapter, besides examining the trends of all responsibility in outreach station…I
infant mortality and child mortality rate, we shall also take all responsibility of ASHA and JSY
discuss about birth weight, neo-natal check-up and fund…I was trained by Dr. Behera of
understanding of breastfeeding practices among Kishore Nagar…it was intensive
women in the program Districts of Orissa. training…about breast feeding…about
new born care…but more training is
required… - Rukuni Prusty, ANM, Village
5.2 Infant Mortality Parasumal, Block Kishore Nagar, Angul
Historically, Orissa is a high infant mortality rate (IMR) state compared to other states of India,
though Infant Mortality Rate has declined drastically during the last two decades.
In 1992-93, the IMR was 112 per 1000 live births in Orissa compared to 79 for all India (NFHS-1).
According to the latest NFHS-3 (2005-06) the figure for Orissa was 65 per 1000 live births. SRS
2006 estimates the IMR of Orissa to be 73 per 1000 live births (Table 2.1a).
Under 5 mortality (U5MR) in Orissa as per NFHS-3 is 91 per 1000 live births, one of the highest
in India, but U5MR has declined by about 30 percent since NFHS-1.
69
NIPI Baseline Report – Orissa
Table 5.2: Trends in Under Five Mortality Rate for Orissa and India
Direct estimates of infant and child mortality indicators at district level are not available, though
estimates using census data on children ever born and children surviving are available but are
inconsistent and not reliable. Hence this data is not presented in this report. The District Level
Household Survey (DLHS 2002-03) does not provide district level infant and child mortality
estimates. Thus no reliable estimate of infant and child mortality is available at the district level.
One of the concern areas is the difference of indicator values from different data sources. For
example SRS figure for infant mortality in Orissa is 73 whereas, NFHS-3 (2005-06) shows an IMR
of 65.
DLHS-2 (DLHS-3 data not available) shows that about two fifth of the children in Orissa were
underweight (weight for age <-2SD), while about 15 percent were severe underweight (weight for
age <-3SD). Angul and Jharsuguda Districts follow the same pattern as of the state (Annexure
18). But the reported underweight for Jharsuguda was much lower (only 10%) and its correctness
needs to be checked. At juxtapose, NIPI Baseline Survey reported that out of the 105 cases
where the weight could be verified from the card, 22.9% 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 66% and 79%.
70
NIPI Baseline Report – Orissa
We have already ascertained that very few babies were actually weighed at birth. However, the
research did give the opportunity to the eligible mothers to recall and record whether they though
the size of the newborn was smaller, larger or as per average.
It can be seen from the table above that overall, although nearly 50% of the mothers across
urban and rural locations thought that their babies were of average or normal size, it may be
worthwhile to note that more than a fifth of the rural mothers and around 15% of the urban
mothers did admit that they perceived their baby to be smaller than average at birth.
71
NIPI Baseline Report – Orissa
This section looks at breastfeeding practices among the eligible women, the attitude and practice
pertaining to feeding of prelacteal liquids and period of exclusive breastfeeding and introduction
of supplementary feeding.
72
NIPI Baseline Report – Orissa
In urban areas it has primarily been the private or government doctors, because of the
preponderance of institutional deliveries.
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, 64 percent started breastfeeding within one hour of
birth and nearly one-fourth (23%) breastfed their child after one hour but on the same day in all
the three districts together. District wise analysis shows that Sambalpur has the highest
percentage (68%) of mothers who started breastfeeding their child within one hour of birth
followed by Jharsuguda (65%) and Angul (59%).
65 68
70 64
59
60
50
Percent
40
30 24 24 23
20
17
20 11 12 13
10
0
Angul Jharsuguda Sambalpur ORISSA
Within one hour after birth
After one hour but within same day
Mothers who have ever breastfed their child
After more than 24 hours
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.
73
NIPI Baseline Report – Orissa
It is quite clear that gender of the child did not have any influence on the time of initiation of
breast milk.
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
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.
Milk other than breast milk (usually goat‘s milk) and infant formula were being given to neonates
by nearly a third of the mothers as part of prelacteal feed. In some locations (viz. rural Angul,
there was also a practice of feeding honey. Overall, it was observed that the practice of
introducing prelacteal liquids was practiced in both urban and rural locations.
74
NIPI Baseline Report – Orissa
Wealth Index
Lowest 653 57.4 484 42.6
Second 170 53.6 147 46.4
Middle 129 50.8 125 49.2
Fourth 140 59.1 97 40.9
Highest 175 50.4 172 49.6
Total 1267 55.3 484 44.7
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.
Overall, a higher proportion of mothers had discontinued exclusive breastfeeding before 6 months
(55.3%) than those who had continued beyond 6 months (44.7%).
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.
75
NIPI Baseline Report – Orissa
Summary observations
It ca be said that there exists across various services an overlap of service providers. While it was
recognised by respondents of various sections, that ANMs formed the backbone of NRHM
activities, there was some lacunae in role-responsibility demarcation of the ASHA and AWW.
In Districts like Jharsuguda and Angul where urban settlement pattern was more pronounced,
there was difficulty in placing ―community‖ based service providers like the ASHA in their right
context. ASHA service for urban milieu was found, due to number of reasons achieving lower
results.
However, in urban and low ―community‖ based service oriented scenario ANM functionality was
found to have been little impacted. In fact in situations where ASHA or AWW was found limited in
their role, ANM was functioning quite satisfactorily.
As regards new born care it was found that AWWs were better suited to deliver these services in
conjunction with ANM.
It has already been stated that ANM as ‗outside‘ agency more often than not functions through
‗local‘ operatives like the ASHA or the AWW.
In situations of urban demographic profile and migrant population scenario, AWW was more
suited as ‗local‘ partner of ANM than ASHA, who in any case had little role in a ―non-community‖
service context.
ASHA role moreover has been overly qualified by their ―commission‖ basis work and in a situation
where ‗other‘ private health options are open; they have anyway very little by way of incentive to
participate in service. AWW on the other being salaried and at par with ANM in government
scheme of things, from a managerial point of view, form a more natural ally of ANM.
76
NIPI Baseline Report – Orissa
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.
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.
As according to NFHS-3, prevalence of ARI among children in India was about 6 percent while it
was about 3 percent in Orissa. Similarly for NIPI Baseline survey (NIPI 08), prevalence of ARI
among children in Orissa was reported slightly higher of 13.5 %.
About one tenth of the children less than 5 years of age had diarrhoea during the two weeks prior
to the survey at all India level while State wise figures for diarrhoea prevalence are not yet
available from NFHS-3. During NFHS-1 and 2, prevalence of diarrhea was higher than all India
average. However NIPI Baseline Survey was reported to be slightly better with about 7% 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 6.3 presents that overall the diarrhoea point prevalence rate (at the time of the survey
contact) was 0.7 % while illness with cough slightly higher of 1.8%.
77
NIPI Baseline Report – Orissa
The period prevalence rate for diarrhoea among children was calculated as part of this study.
Overall the period prevalence rate (last 2 weeks prior to the survey contact) was 7%, which varied
between 6.8% in rural areas and 7.7% in urban areas. The period prevalence levels were highest
in Jharsuguda (8.4% rural and 7.5% urban) and lowest in Angul District (5.5% and 5.0%
respectively).
53
60
50
40 29.1
30
10.9 14.2
20 10.9
4.9 6.1
10
78
NIPI Baseline Report – Orissa
Around 29% of mothers had continued to breastfeed during this process. Around 11% had made
their own salt and sugar solution and given to the child.
The propensity to give ORS to a child suffering from diarrhoea does not seem to increase with the
education of the mother as the data does not capture any definitive trend in usage.
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.
Out of the 247 cases of diarrhoea in the previous 2 weeks prior to the survey contact, only 114
cases (46.2%) where the ANM or any other health worked had given advice on what needs to be
done in terms of treatment.
According to NFHS-3, more than half (58.6%) of the children in Orissa were taken to a health
facility when they had diarrhoea in the two weeks prior to the survey. While NIPI baseline survey
reveals that the usual place for diarrhoea treatment was the government hospital. In nearly 70%
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:
3/4th of the women had not discontinued breastfeeding while their child was suffering 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. (Annexure A10)
Food intake was also reduced with 61% mothers saying they did so.
125 out of the189 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 or the ANM/ASHA/LHV. (Annexure A10)
79
NIPI Baseline Report – Orissa
An attempt was made to understand the awareness level of term pneumonia, and mothers
awareness on symptoms of pneumonia. This is presented in the table 6.5 and figure 2.
90
80 Difficulty in Breathing
70 Chest Indrawing
60 Not able to take feed
50 Exclusive Drowsy
40 Pain in chest
30 Condition gets worst
20 Wheezing
10 Rapid Breathing
0 Others
Rural Urban Total
Of those who were aware of pneumonia, most (77%) knew that it was accompanied by difficulty
in breathing, pain in the chest (56.4%) and not able to take feed (36%).
Prevalence of ARI has reduced considerably from 19.3% to 5.8% in India during NFHS-2 and
NFHS-3. In Orissa, it has reduced from 22.5% to 2.8% during the same time period.
80
NIPI Baseline Report – Orissa
Orissa 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 during two
2.8 22.5 10.4 5.8 19.3 6.5
weeks prior to survey
Source: NFHS 2 and 3 (fact sheets)
Prevalence of pneumonia in rural areas of the program Districts combined was 3.9% (ever
suffered) while it was 3.3% in the urban areas.
Overwhelmingly almost everyone had consulted a qualified doctor for treatment of their child.
(see the table below)
Chemist shop 1 2.3 0.0 0.0 0.0 0.0 0.0 0.0 1 3.8 0.0 0.0 2 1.6 0.0 0.0 2 1.6
Total 39 90.7 4 9.3 36 67.9 17 32.1 21 80.8 5 19.2 96 78.7 26 21.3 122 100
6.3 Fever
6.3.1 Illness with fever and cough and treatment seeking behaviour
Table 6.8: Incidence of fever and cough among children in last 2 weeks prior to survey contact
The period prevalence rate for fever/cough among children was calculated as part of this study.
Overall the period prevalence rate (last 2 weeks prior to the survey contact) was 13.5%, which
varied between 13.4% in rural areas and 13.6% in urban areas. The period prevalence levels
were highest in Jharsuguda urban (16.8%) and lowest in Angul District urban (5%).
81
NIPI Baseline Report – Orissa
Nearly half of the children had suffered from their bought of fever/cough for at least one week and
80% had suffered for more than 3 days. (Annexure A12)
36% of the mothers had reported that during this period, their child had chest congestion while
33% had reported that they had both chest congestion as well as a runny nose. Only 16% had
reported of runny nose as the only outward manifestation of the ailment.( Annexure A13)
In 78% of the cases, the medicine for treatment came from the doctor himself/herself while only
around 9% had procured the medicine directly from the chemist shop. (Annexure A12)
85% had reported that they did not face any problem in procuring the prescribed medicine.
It was the usual case to find multiple service providers in the same area, viz., ASHA and AWW,
yet much left to be desired of the help received by mothers and infants.
While AWW was busy with taking care of the children under her supervision, ASHA was not
aware of any emergency that might have come to notice of AWW.
And it was vice versa, when ASHA came to know of any critical case, she also waited for ANM to
refer her case to, with AWW remaining in the dark
68% of the mothers in the rural areas had reported that they had reduced liquid intake for their
child during their bout of illness with fever/cough, while 26% had not done so. This was similar in
82
NIPI Baseline Report – Orissa
urban areas where 65% of the mothers had reported reducing liquid intake for their child.
(Annexure A11)
The situation with food intake was almost exactly similar. Here 66% of the mothers in the rural
areas had reported that they had reduced food intake for their child during their bout of illness
with fever/cough, while 26% had not done so. This was similar in urban areas where 63.5% of the
mothers had reported reducing food intake for their child. (Annexure A11)
The following section looks at various facets of treatment …there should be stock of medicines
and preventive measures having been taken, money spent in sub-centre…all vaccines should
on treatment and problems faced if any in getting the always be in stock…the BP and
desired treatment for the child. Overall, 85% of the weight machine should be in working
mothers had confirmed that their child was being given order…- Bilasini Nayak, ANM, Village
medicines for their illness. 77% had conformed that they Banharpuli, Block Lakhanpur,
had started giving medicines within 24 hours of detecting Jharsuguda
the illness. (Annexure A15)
70
60
50
40
30
20
10
0
Rural Urban Total
Mosquito Net Purified Drinking Water Keep the baby covered Others
Among those families who had taken their child to a
“…there is no fund or advance health facility/health care provider for
separately for us to conduct our treatment/diagnosis, 68% in the rural areas and 88% in
day to day activities, …if we are the urban areas had reported that they had not faced
given funds we can manage it very any problem in the process. (Annexure A14)
well, …only meetings are held but
we are given no funds to mange 48% in rural areas and 42% in urban areas had spent
on our own…” – Sandhyarani between Rs.200 to less than Rs.100 for treatment of
Nayak, ASHA, Village their child. 31% in rural areas and 37% in urban areas
Burokhamunda, Block Jharsuguda. had spent between Rs.201 and Rs.500. The rest had
either spent more or not spent any money at all.
(Annexure A16)
83
NIPI Baseline Report – Orissa
Summary observation
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.
The role of ASHAs particularly in the rural areas needs to be made more comprehensive and
inclusive. This service provider must be pulled out of its fast attaining stigma of being
―commission‖ based health worker.
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. This
latter health service in this preset study time and again expressed the desire to be treated as a
quasi medical professional and not just as a nurse or ‗qualified‘ ―dai‘.
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.
84
NIPI Baseline Report – Orissa
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 survial
programme. As part of the National Health Policy, the National Immunization Programme is being
implemented on a priortiy basis. The Government of India initatied the expanded Programme on
Immunisation (EPI) in 1978 with the objective of reducing morbidity, mortality and disabilties
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 agaisnt six vaccine prevalentable 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.
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: Percent 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) 700 66.7 117 83.6 621 79.3 354 83.1 691 79.9 281 82.4 2,012 74.6 752 82.9 2,764 76.7
Yes (card not seen) 213 20.3 19 13.6 134 17.1 62 14.6 148 17.1 54 15.8 495 18.4 135 14.9 630 17.5
No card 136 13.0 4 2.8 28 3.6 10 2.3 26 3.0 6 1.8 190 7.0 20 2.2 210 5.8
Total # of children 1,049 100. 140 100 783 100. 426 100.0 865 100 341 100.0 2,697 100.0 907 100 3,604 100
85
NIPI Baseline Report – Orissa
Table 7.2: BCG and Polio „0‟ coverage by background variables, NIPI-08
BCG Polio 0
Districts N % N %
Angul 370 98.4 184 48.9
Jharsuguda 441 98.4 256 57.1
Sambalpur 441 97.8 198 43.9
Sex of the Child
Boy 658 98.2 350 52.2
Girl 594 98.2 288 47.6
Location of PSU
Rural 921 98.2 421 44.9
Urban 331 98.2 217 64.4
Births order of Child
1 545 98.6 292 52.8
2-3 558 98.1 271 47.6
4-5 119 98.3 57 47.1
6+ 30 93.8 18 56.3
BCG Polio 0
Years of schooling of mother N % N %
No schooling 396 96.8 183 44.7
<5 120 98.4 49 40.2
5-7 211 99.1 102 47.9
8-9 247 98.8 122 48.8
10-11 133 98.5 77 57.0
12 & above 145 99.3 105 71.9
In all the sampled districts as high as 98 percent children received BCG but Polio ‗0‘ coverage
was near about 50%. The coverage of Polio ‗0‘ was highest in Jharsuguda (57%) but much lower
in Sambalpur (44%) and Angul (49%).
Coverage of Polio 0 was marginally higher among boys than girls but not significantly slow to
conclude in favour of any gender bias in coverage. Polio 0 coverage in urban areas is a good 20
percentage points more than in rural areas.
The birth order has not had any influence on coverage of 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.
86
NIPI Baseline Report – Orissa
The incidence of Polio 1,2 and 3 having been given to the index child is very high and with little
variations across background variables. Relatively speaking, there is a coverage leakage of OPV
3 to the tune of 11.2% in Angul and around 8.4% in Sambalpur District.
Table 7.4 : Child Immunisation Coverage in NIPI Districts, Orissa
DLHS-3 shows that nearly three fourth of the children received all three doses of DPT vaccination
in Orissa while equal doses of DPT was recorded in Jharsuguda (82%) and Sambalpur (82%).
Consequently a slightly lower coverage of DPT vaccination was observed in Angul (all three
doses of DPT vaccination.) (See table 7.4).
As compared to Phase II, DPT coverage is also fairly high but drops progressively from dose 1 to
dose 3. Once again, highest coverage was observed in Jharsuguda (even DTP 3 coverage was
96%) and lowest was in Angul District. In fact, dropout was also observed to be the highest in
Angul (from 96.6% dose 1 to 88.8% dose 3).
87
NIPI Baseline Report – Orissa
There was 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 Angul District was poor (62.5% measles vaccine coverage and
54.5% Vitamin A coverage). In comparison, the coverage of both in Jharsuguda and Sambalpur
were close to 80% or above.
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 7 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 (81.7% measles vaccine coverage
and 73% Vitamin A coverage) than those for whom this was the fourth child or more (69.4% and
62.5% 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 67% of the illiterate mothers
th
having children with measles vaccine as against mothers who were educated beyond the 10
standard (over 90% coverage).
88
NIPI Baseline Report – Orissa
Districts N %
Angul 229 60.9
Jharsuguda 377 84.2
Sambalpur 350 77.6
BCG
DPT 1, 2 and 3
OPV 1, 2 and 3
Measles
Incidence of full coverage did not vary significantly with the location of the PSU with rural
coverage being 74.7% and urban, 75.7%. 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 only
2.4% 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 (79% coverage) than those for whom
this was the fourth child or more (67.8% to 62.5%). 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 65% of the illiterate mothers having
th
children fully immunized as against mothers who were educated beyond the 10 standard (87-
90% coverage).
89
NIPI Baseline Report – Orissa
N % N % N % N %
In- Laws Home 10 6.9 4 3 14 2.8
Parents Home 1 0.5 2 1.4 3 0.6
Other Home 1 0.7 1 0.2
Government/Municipal Hospital 5 2.3 9 6.3 16 11.9 30 6.1
Government Dispensary 2 1.4 1 0.7 3 0.6
UHC/UHP/UFWC 2 1.4 1 0.7 3 0.6
CHC/Rural hospital 1 0.5 4 2.8 2 1.5 7 1.4
PHC 5 2.3 7 4.9 14 10.4 26 5.3
Sub Center 18 8.4 29 20.1 49 36.6 96 19.5
NGO/Trust hospital/Clinic 1 0.7 1 0.2
Govt/AYUSH.Hospital/ Clinic 1 0.5 1 0.2
Private hospital/Clinic 8 3.7 6 4.2 7 5.2 21 5.1
Other 176 81.8 71 56.1 40 33 287 60.2
Total 215 100.0 144 100.0 134 100.0 493 100
Table 7.7 shows the place at which most of childhood vaccinations received in programe Districts
were other health facilities. About 6% of children were immunized at the government and
municipal hospital. Further, among the children immunized, 20% of them were immunized from
the Sub Centre, 5% from Public Health Center and 2 % from Community Health Centre/ Rural
hospital. The percentage or children receiving vaccination from the Private hospital/clinic in the
overall program Districts is very low.
DISTRICT
Angul Jharsuguda Sambalpur
Total Total Total
N % N % N %
No time from daily wage work 42 3.6 11 0.9 31 2.6
Distance of Health Facility/ Vaccination Centre 88 7.6 41 3.5 47 4
Irregular presence of health professional 20 1.7 29 2.4 14 1.2
Non- availability of vaccines 12 1 38 3.2 60 5.1
Don't Know / Can‘t say 82 7.1 19 1.6 42 3.6
No Problem Faced 922 77.4 1,043 87.1 987 82.9
Any other 22 1.6 16 1.3 7 0.6
Total 1,161 100.0 1,186 100.0 1,176 100.0
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 was cited as a deterrent in Angul.
90
NIPI Baseline Report – Orissa
There was some distinction between ‗rural‘ ASHA and those functioning in ‗urban‘ settlements.
The latter had more of a role in assisting the ANM, since the ANMs themselves were well positioned
and easily accessible to the people in urban areas.
The major roles were that of arranging for immunization camps and maintain certain ‗birth‘ and
‗pregnancy‘ diaries and registers.
Accompaniment with mother for institutional delivery and involvement in ANC or PNC work was limited
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. Though figures for
Sambalpur and Angul coincide but reasons for their respective rates of drop out are very different.
In Sambalpur, distance and remoteness of village sub-centres was a major factor affecting
government initiatives.
In Angul the semi-urban nature of the District and heterogeneity of population was important
along with the fact that the District was nearest to state capital, Bhubaneswar, and there were a
number of ‗other‘ private options available outside the government initiative.
91
NIPI Baseline Report – Orissa
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 was implementing Maternal and
New born Care program in the country. Under this program a range of maternal and newborn
care services were being provided through a network of government health facilities. The
program also aims to strengthen health infrastructure in terms of trained staff, equipment and
supplies to enable the facilities to provide good quality MNC services.
The purpose of facility survey, NIPI intervention Districts were to understand the status of health
facilities at all the levels.
In the hierarchical health care system of the Government of India in a District, the District hospital
was the apex body, which provides specialized health care services to people on subsidized
costs. Every District was expected to have a District hospital. The information collected and
analyzed in this section relates to 3 District hospitals of Orissa.
Physical infrastructure was comparatively good for the 3 NIPI District. All three had a separate
government building with 24-hour water supply. All the District hospitals had three-phase
electricity connection. But the standby facility in the form of generator was available only in two
hospitals. All the three District hospitals had functional toilet facility separately for male and
female.
In two hospitals not all sections of the hospital were connected by phone. All the DHs had at least
one vehicle and one ambulance.
Senior doctors, specialists, GY/OB and anesthetist were in position in all the District hospitals.
While number of general duty doctors and junior doctors was insufficient.
Similarly most of the sanctioned posts of various staff, such as staff nurses, ANM and Midwife for
conducting deliveries were filled and available at the time of interview.
The investigative and laboratory facility were available in all the District hospitals. Apart from this
two X-ray and ultrasound facilities were also available in all 3 Districts.
In all, there were 7 wards in three DH, number of wards vary between all District hospitals. There
were about 250 beds in 3 hospitals. These were 98 in Angul, 62 in Jharsuguda and 90 in
Sambalpur. The maximum number of beds found in a single unit was 30 beds. In other hospitals
the number of beds varies between 41 in one and 105 in another hospital. All the hospitals had
separate female and pediatric wards. The occupancy rate of maternity beds was quite high in
past 6-7 month; this may be because of JSY or increase in awareness level of general
92
NIPI Baseline Report – Orissa
community. On the other hand the occupancy rate of pediatric beds was very low in past 6
months.
OT was available for major surgeries and separate Labour rooms for conducting deliveries.
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.
All the District hospitals had 24-hour obstetrician/gynecological, amethyst, nurse available for
emergency obstetrics services, along with this all the hospitals provide 24 hours surgical
intervention.
All the District hospitals had essential facility available for normal and assisted delivery, other
gynecological disorders and treatment for low birth weight children.
As given in Indian Public Health Standards (IPHS) all the District hospitals have sufficient number
of human resources (both clinical and paramedical). The operation theater and labour rooms are
adequate and have all essential instruments.
All the laboratories are working in proper way as per IPH standards.
For details of facility survey conducted among District Hospitals in all three NIPI Districts, please
refer to Table A6 – A17 given in Annexure Tables.
Though not designated as such, community health centres were also first referral units where
referral cases from lower level health care establishments were sent. The CHCs had to take care
of these cases besides their usual health care activities. One CHC from each District was
selected for the study.
8.3.1 Infrastructure
All the three CHCs were in the government building with regular supply of water and electricity.
All the CHCs had functional toilet facility separately for men and women.
In the all the CHCs, General surgeon, Physician, GYOB and General Medical officer were in
position. Along with them public health program managers were also found in place.
Similarly staff nurses, ANM and midwife were in position and on contract also. Post of
pharmacist, radiographer and dresser were filled with adequate number of staff. Staff and ANM
were available around the clock, while gynecologist and anesthetist were available on call in case
of emergency.
93
NIPI Baseline Report – Orissa
8.3.3 Training
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.
Availability of all essential equipments required for surgical and non-surgical treatment was also
investigated as part of the facility survey and the result are provided in the Annexure to this
report.
All the CHCs had 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 camps, apart from this treatment
for other gynecological disorder and MTP was also available for women.
As per IPHS all CHCs are working in proper ways, number of human resources (clinical and
paramedical staff) adequate in numbers. There is shortfall of essential instrument and medicine
was observed during the survey.
The condition of labour rooms and OT were good, all the CHCS have lab facility as the IPHS
norms.
For details of facility survey conducted among CHCs in all three NIPI Districts, please refer to
Table A18 – A39 given in Annexure Tables.
The primary health centres had 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 in patient and out patient services.
Compared to DHs and sub-divisional Hospitals, PHCs were accessible to a larger population.
However, just the availability of PHCs was 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 Orissa, 20 PHCs were covered under the survey.
Except one PHC all the surveyed PHCs had their own buildings, out of 20, 17 PHCs had pucca
buildings, whereas remaining 3 had semi pucca buildings respectively.
Almost in all the PHCs there was supply of water for 24 hours. In all 12 PHCs got supply of water
through own bore well, while in remaining PHCs water was provided by block irrigation
department.
Regular supply of electricity was observed in 15 PHCs, while 3 PHCs received 12 hours of
electricity supply. However 2 PHCs had no electricity connection.
94
NIPI Baseline Report – Orissa
16 PHCs had toilets facility; out of this 7 PHCs had separate toilets for male and female. The
remaining PHCs did not have this facility. Among the PHCs most of the units had pit toilets.
The survey also assessed the availability of medical and paramedical staff of various categories
and their service training status. It was found that most of the sanctioned posts of medical officers
in all the PHCs were filled. In all 3 medical officers each from 20 across PHCs got training on
Integrated Skill Development training under RCH program, and one MO each from the 20 PHCs
received training on medical termination of pregnancy.
Public health nurses and Staff nurses were in position in 13 PHCs, while ANM were found in
position in 9 PHCs. 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.
Operation Theater was available and functional in 11 PHCs, while 15 PHCs had separate well-
equipped Labour room facility. In 4 PHCs fumigation was being done regularly. Separate ANC
clinic, was available in 16 PHCs respectively and in all these PHCs rooms were being utilized for
the purpose they were meant for.
It was found that Kit A, B, C and D had been available and functional in 5 PHCs only. Kits for
essential obstetric care were supplied in 4 PHCs respectively. Normal delivery kit and vacuum
assisted delivery kit was found in 18 and 13 PHCs respectively. Incubator was available in only
one PHC.
The immunization vaccines such as BCG, DTP, OPV measles, DT and TT were available in
sufficient quantity in all the PHCs. These were 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 20 PHCs. The supply of
these items was reported to be regular. ANM directly procure these from the concerned CHCs
and distribute them further in their respective areas.
8.4.5 Furniture
Essential furniture like, examination table, delivery table, wheel chair, stretcher trolley was
available in 14 out of 20 PHCs, while oxygen trolley was available in 11 PHCs only. However 17
PHCs had iron beds available for in-patient, though the numbers of beds was not sufficient in any
of the PHC.
As we know PHCs are basic public health units for rural community, where people get treatment
from trained medical professionals. The surveyed PHC‘s did not have sufficient number of staffs.
The medicine and medical instruments were inadequate in numbers.
Most of PHCs have Labour rooms as per IPHS, but absence of electricity is major concern.
95
NIPI Baseline Report – Orissa
For details of facility survey conducted among PHCs in each NIPI District, please refer to Table
A40 – A50 given in Annexure Tables.
Sub-centers were the most peripheral health institutions catering to the health care needs of the
rural population. It was the most peripheral contact point between the Primary Health Care
system and the community. It was manned by one multipurpose worker (male) and one
multipurpose worker (female)/ANM. This section presents the findings of 90 SCs from three
Districts of Orissa.
Total of 90 SCs were surveyed for the study, in which 44 SC were in government building, 10 in
rented building and remaining 36 were in rent free panchayat building. Only 50 % of SCs had
regular water and electricity supply.
8.5.2 Staff
All the surveyed SCs had ANM, female health worker and male health workers; most of the
ANMs were serving from 5 to 10 year in particular area. As part of regular activities all the ANMs
went for regular visits in the villages for immunization and for ANC and PNC checkups.
It was found that only 15 % of ANMs were residing in the sub center village.
8.5.3 Training
Almost all the Sub center staff had received training on DOTs, Immunization, plus polio,
integrated management of neonatal and childhood illnesses (IMNCI) instruction and VBDCP.
Regular supply of essential medicines, vaccine and contraceptives were observed in almost all
the sub centers. It was reported by most of the ANMs that they personally had to visit CHC for
collection of vaccine a day before immunization day.
ORS and other medicine were available in 85% of the Sub centers, while delivery kit was
available only in 20 % of the sub centers. A separate Labour room was available only in 15 % of
the sub centers.
For details of facility survey conducted among SCs in each NIPI District, please refer to Table
A51 – A59 given in Annexure Tables.
This is one of the activities of NRHM that needs to be strengthened in Orissa. Districts have
started using the HMIS formats provided under the NRHM, but the compliance of this is not up to
the mark in the NIPI districts. Computers are provided at the block level, which are mostly
functioning, as reported by the district officials. Utilisation of data for monitoring purposes is
another neglected area. In fact, there is no major initiative for monitoring of different activities
taken place in the districts.
96
NIPI Baseline Report – Orissa
In NIPI districts, separate registers for immunisation, untied fund, action plan, HMIS, TB (DOTS),
Leprosy, malaria, Filaria, accounting records, etc are maintained at the district level. The records
maintained by ANM include immunisation, JSY, Malaria, MDT, TB, EC register, contraceptive
register, action plan, ANC, etc.
The information is collected at the grassroots by ANM. She sends the report to PHC level. From
PHCs data will be sent to Block. At the block level the data will be compiled and a data sheet will
be sent to the district HQ.
In this section, details regarding funds allocated and utilised for different activities under NRHM
are presented.
Till December 2007, in Anugul, about four fifth of the money disbursed to them was spent, while
in Sambalpur about half of the funds allocated were utilised. Thus complete utilisation of the
funds allocated or received is an area that needs attention.
The fund utilization status for different activities in Anugul district shows that all the allocated
money was spent for setting up infrastructure in the District Programme Management Unit
(DPMU), while only 7 percent was spent on training of programme managers. About three fourth
of the amount allocated for immunisation was spent indicating partial utilisation of the allocated
funds.
The fund utilization in Sambalpur district (till December 2007) shows about half of the amount
allocated for different heads under IMNCI training was spent. In case of immunisation, about two
third of the amount allocated for the financial year was spent till December 2007.
Fund utilization in Jharsuguda (Table 8.1) shows that about two third of the funds allocated for
immunization was spent, while more than four fifth of the fund allocated for JSY was utilized.
The Facility Survey (DFID) provides information on availability of funds with FRUs. More than
half of the FRUs have funds for operating ambulances, while more than one third have funds for
running generator. Thus in majority of the FRUs, funds are not available for running ambulance
and generator. It is good to note that the RKS funds are used for maintenance of generator, hiring
referral transport and purchase of drugs (Table 8.2).
97
NIPI Baseline Report – Orissa
98
NIPI Baseline Report – Orissa
Annexure
District
Orissa
Angul Jharsuguda Sambalpur
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
Household Goods
Mattress Yes 31.6 62.3 35.1 17.9 55.9 31.2 19.0 48.8 27.4 23.5 54.0 31.2
No 68.4 37.7 64.9 82.1 44.1 68.8 81.0 51.2 72.6 76.5 46.0 68.8
Mosquito net Yes 58.6 79.0 60.9 74.3 76.1 74.9 64.0 73.6 66.7 64.9 75.5 67.5
No 41.4 21.0 39.1 25.7 23.9 25.1 36.0 26.4 33.3 35.1 24.5 32.5
A cot/bed Yes 67.8 80.4 69.2 79.9 86.0 82.0 76.5 86.6 79.4 74.1 85.4 77.0
No 32.2 19.6 30.8 20.1 14.0 18.0 23.5 13.4 20.6 25.9 14.6 23.0
Chair Yes 49.4 71.7 52.0 55.2 73.1 61.5 42.8 62.7 48.5 48.9 68.8 53.9
No 50.6 28.3 48.0 44.8 26.9 38.5 57.2 37.3 51.5 51.1 31.2 46.1
Table Yes 28.1 60.1 31.8 42.2 63.9 49.8 31.1 55.9 38.1 33.1 60.2 39.9
No 71.9 39.9 68.2 57.8 36.1 50.2 68.9 44.1 61.9 66.9 39.8 60.1
Pressure cooker Yes 20.5 53.6 24.3 24.3 56.6 35.6 14.7 48.0 24.1 19.6 52.8 28.0
No 79.5 46.4 75.7 75.7 43.4 64.4 85.3 52.0 75.9 80.4 47.2 72.0
Radio or Transistor Yes 14.9 19.6 15.4 12.1 16.3 13.6 11.8 10.9 11.5 13.0 14.7 13.4
No 85.1 80.4 84.6 87.9 83.7 86.4 88.2 89.1 88.5 87.0 85.3 86.6
Watch or clock Yes 58.8 85.5 61.8 72.8 88.3 78.2 64.0 87.2 70.6 64.5 87.4 70.3
No 41.2 14.5 38.2 27.2 11.7 21.8 36.0 12.8 29.4 35.5 12.6 29.7
Sewing Machine Yes 4.5 18.1 6.0 10.0 21.6 14.0 8.1 16.3 10.4 7.2 19.0 10.2
No 95.5 81.9 94.0 90.0 78.4 86.0 91.9 83.7 89.6 92.8 81.0 89.8
Electricity Yes 33.9 74.6 38.6 62.9 86.2 71.1 44.9 90.7 57.9 45.9 86.3 56.0
No 66.1 25.4 61.4 37.1 13.8 28.9 55.1 9.3 42.1 54.1 13.7 44.0
An Electric fan Yes 31.3 76.8 36.5 53.2 82.5 63.5 36.7 82.8 49.8 39.4 81.8 50.0
No 68.7 23.2 63.5 46.8 17.5 36.5 63.3 17.2 50.2 60.6 18.2 50.0
Television Yes 24.9 65.9 29.6 50.6 75.9 59.5 36.7 75.2 47.6 36.2 74.1 45.7
No 75.1 34.1 70.4 49.4 24.1 40.5 63.3 24.8 52.4 63.8 25.9 54.3
Refrigerator Yes 7.9 42.0 11.8 10.4 34.3 18.8 6.5 30.5 13.3 8.2 33.9 14.6
No 92.1 58.0 88.2 89.6 65.7 81.2 93.5 69.5 86.7 91.8 66.1 85.4
Computer Yes 0.9 4.3 1.3 2.5 7.4 4.2 1.4 8.2 3.3 1.5 7.2 3.0
No 99.1 95.7 98.7 97.5 92.6 95.8 98.6 91.8 96.7 98.5 92.8 97.0
Mobile phone Yes 22.0 58.0 26.1 31.8 61.8 42.4 19.5 59.4 30.8 24.0 60.3 33.1
No 78.0 42.0 73.9 68.2 38.2 57.6 80.5 40.6 69.2 76.0 39.7 66.9
Any Other type of telephone Yes 4.0 18.1 5.6 3.6 12.6 6.8 4.3 12.8 6.7 4.0 13.5 6.4
No 96.0 81.9 94.4 96.4 87.4 93.2 95.7 87.2 93.3 96.0 86.5 93.6
Water pump Yes 7.2 4.3 6.9 9.8 12.9 10.9 6.3 13.6 8.3 7.6 11.9 8.7
No 92.8 95.7 93.1 90.2 87.1 89.1 93.7 86.4 91.7 92.4 88.1 91.3
Thresher Yes 1.3 0.7 1.2 1.1 0.5 0.9 1.1 0.8 1.0 1.2 0.6 1.0
No 98.7 99.3 98.8 98.9 99.5 99.1 98.9 99.2 99.0 98.8 99.4 99.0
Tractor Yes 1.9 0.7 1.7 3.9 3.0 3.6 2.0 1.4 1.9 2.5 2.0 2.4
No 98.1 99.3 98.3 96.1 97.0 96.4 98.0 98.6 98.1 97.5 98.0 97.6
Bicycle Yes 73.8 73.2 73.8 83.0 76.1 80.5 80.2 74.7 78.6 78.5 75.1 77.7
No 26.2 26.8 26.2 17.0 23.9 19.5 19.8 25.3 21.4 21.5 24.9 22.3
An animal drawn cart Yes 10.0 4.3 9.4 6.2 1.1 4.4 3.3 0.8 2.6 6.7 1.5 5.4
No 90.0 95.7 90.6 93.8 98.9 95.6 96.7 99.2 97.4 93.3 98.5 94.6
A car/Jeep Yes 0.8 2.2 1.0 1.4 3.9 2.3 1.0 4.4 1.9 1.0 3.8 1.7
No 99.2 97.8 99.0 98.6 96.1 97.7 99.0 95.6 98.1 99.0 96.2 98.3
Two wheeler/ motorbike Yes 12.5 49.3 16.7 20.1 44.8 28.8 12.3 34.3 18.5 14.6 41.4 21.4
No 87.5 50.7 83.3 79.9 55.2 71.2 87.7 65.7 81.5 85.4 58.6 78.6
99
NIPI Baseline Report – Orissa
District
Orissa
Angul Jharsuguda Sambalpur
Wealth Index
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
Lowest 65.4 23.9 60.7 45.6 17.9 35.9 61.1 19.3 49.2 58.3 19.4 48.5
Second 10.3 13.8 10.7 16.7 13.3 15.5 14.0 18.8 15.4 13.4 15.5 13.9
Middle 8.2 3.6 7.7 15.3 13.1 14.5 11.7 13.6 12.2 11.4 11.9 11.5
Fourth 7.9 18.1 9.0 12.3 17.2 14.0 6.1 13.1 8.1 8.6 15.7 10.4
Highest 8.2 40.6 11.9 10.1 38.4 20.0 7.1 35.1 15.1 8.4 37.4 15.7
Total 100 100 100 100 100 100 100 100 100 100 100 100
Total number of HH 1070 138 1208 804 435 1239 927 367 1294 2801 940 3741
100
NIPI Baseline Report – Orissa
101
NIPI Baseline Report – Orissa
102
NIPI Baseline Report – Orissa
A7-Employment Status
103
NIPI Baseline Report – Orissa
104
NIPI Baseline Report – Orissa
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 %
Age of the Respondent (in Years)
15-18 2 66.7 1 33.3 3 100
19-21 30 53.6 6 10.7 7 12.5 16 28.6 6 10.7 9 16.1 1 1.8 56 100
22-25 56 53.8 12 11.5 9 8.7 31 29.8 4 3.8 16 15.4 6 5.8 104 100
26-30 31 52.5 3 5.1 10 16.9 18 30.5 5 8.5 8 13.6 2 3.4 59 100
31-40 12 48 6 24 1 4.0 7 28 1 4 3 12.0 25 100
Total 131 53 27 10.9 27 10.9 72 29.1 15 6.1 35 14.2 12 4.9 247 100
Education of the Respondent
No Education 43 47.8 9 10.0 12 13.3 23 25.6 9 10.0 15 16.7 4 4.4 90 100.
<5 18 60.0 3 10.0 3 10.0 10 33.3 1 3.3 2 6.7 4 13.3 30 100.
5-7 25 56.8 7 15.9 4 9.1 14 31.8 1 2.3 5 11.4 2 4.5 44 100.
8-9 21 47.7 4 9.1 4 9.1 13 29.5 3 6.8 7 15.9 2 4.5 44 100.
10-11 14 60.9 1 4.3 2 8.7 7 30.4 1 4.3 1 4.3 23 100.
12 & Above 10 62.5 3 18.8 2 12.5 5 31.3 5 31.3 16 100
Total 131 53 27 10.9 27 10.9 72 29.1 15 6.1 35 14.2 12 4.9 247 100
Number of Living Children
1-2 101 53.7 14 7.4 20 10.6 55 29.3 10 5.3 32 17.0 9 4.8 188 100
3-4 27 56.3 10 20.8 4 8.3 15 31.3 5 10.4 2 4.2 2 4.2 48 100
5+ 3 27.3 3 27.3 3 27.3 2 18.2 1 9.1 1 9.1 11 100
Total 131 53.0 27 10.9 27 10.9 72 29.1 15 6.1 35 14.2 12 4.9 247 100
Locality
Rural 89 49.7 20 11.2 19 10.6 47 26.3 13 7.3 28 15.6 11 6.1 179 100.
Urban 42 61.8 7 10.3 8 11.8 25 36.8 2 2.9 7 10.3 1 1.5 68 100
Total 131 53.0 27 10.9 27 10.9 72 29.1 15 6.1 35 14.2 12 4.9 247 100
Wealth Index
Lowest 58 46.4 14 11.2 14 11.2 37 29.6 11 8.8 11 8.8 11 8.8 125 100
Second 27 65.9 7 17.1 6 14.6 9 22.0 2 4.9 9 22.0 41 100
Middle 17 56.7 2 6.7 3 10.0 10 33.3 7 23.3 1 3.3 30 100
Fourth 11 45.8 2 8.3 3 12.5 9 37.5 2 8.3 2 8.3 24 100
Highest 18 66.7 2 7.4 1 3.7 7 25.9 6 22.2 27 100
Total 131 53.0 27 10.9 27 10.9 72 29.1 15 6.1 35 14.2 12 4.9 247 100
105
NIPI Baseline Report – Orissa
106
NIPI Baseline Report – Orissa
District
Total
Angul Jharsuguda Sambalpur
Rural Urban Rural Urban Rural Urban Rural Urban Total
N % N % N % N % N % N % N % N % N %
Quantity of drink given during the illness
Much Less 28 20.4 2 28.6 12 14.6 11 15.7 24 17.8 7 15.9 64 18.1 20 16.5
84 0.3
Somewhat Less 70 51.1 3 42.9 50 61.0 38 54.3 57 42.2 18 40.9 177 50.0 59 48.8
236 0.4
About The Same 27 19.7 2 28.6 17 20.7 19 27.1 48 35.6 15 34.1 92 26.0 36 29.8
128 4.0
More 2 1.5 1 1.2 1 1.4 1 0.7 1 2.3 4 1.1 2 1.7
6 100
Nothing To Drink 10 7.3 1 1.2 1 1.4 5 3.7 3 6.8 16 4.5 4 3.3
20 19.9
Don‘t Know 1 1.2 1 0.3 1 100
Total 137 100 7 100 82 100 70 100 135 100 44 100 354 100 121 100 475 0.3
Quantity of food given during the illness
Much Less 22 16.1 2 28.6 12 14.6 11 15.7 16 11.9 6 13.6 50 14.1 19 15.7 69 35.2
Somewhat Less 77 56.2 2 28.6 49 59.8 39 55.7 58 43.0 18 40.9 184 52.0 59 48.8 243 13.6
About The Same 25 18.2 3 42.9 16 19.5 17 24.3 52 38.5 16 36.4 93 26.3 36 29.8 129 100
More 2 1.5 1 1.2 1 0.7 1 2.3 4 1.1 1 0.8 5 1.1
Stopped Food 1 0.7 1 1.2 3 2.2 5 1.4 5 1.1
Never Gave
9 6.6 3 3.7 3 4.3 5 3.7 3 6.8 17 4.8 6 5.0 23 4.8
Food
Don‘t Know 1 0.7 1 0.3 1 0.2
Total 137 100 7 100 82 100 70 100 135 100 44 100 354 100 121 100 475 100
107
NIPI Baseline Report – Orissa
A12- Advice received from sources & duration of treatment for illness
District Total
Angul Jharsuguda Sambalpur
Rural Urban Rural Urban Rural Urban Rural Urban Total
Advice or treatment N % N % N % N % N % N % N % N % N %
Same Day 9 12.7 3 42.9 12 27.9 8 19.0 7 10.8 7 18.4 28 15.6 18 20.7 46 17.3
2 days ago 48 67.6 2 28.6 24 55.8 29 69.0 45 69.2 28 73.7 117 65.4 59 67.8 176 66.2
3 - 4 days ago 9 12.7 2 28.6 7 16.3 4 9.5 10 15.4 1 2.6 26 14.5 7 8.0 33 12.4
5 - 6 days ago 3 4.2 1 1.5 4 2.2 4 1.5
Week or more than a 2 2.8 1 2.4 2 3.1 2 5.3 4 2.2 3 3.4 7 2.6
week ago
Total 71 100 7 100 43 100 42 100 65 100 38 100 179 100 87 100 266 100
Advise received from sources during illness
Government/ 17 23.9 2 28.6 6 14.0 7 16.7 12 18.5 19 50.0 35 19.6 28 32.2 63 23.7
Municipal Hospital
Government 1 1.4 1 2.3 2 1.1 2 0.8
Dispensary
CHC/ Rural Hospital 10 14.1 3 42.9 5 11.6 2 4.8 14 21.5 29 16.2 5 5.7 34 12.8
PHC 23 32.4 1 14.3 9 20.9 2 4.8 17 26.2 4 10.5 49 27.4 7 8.0 56 21.1
Sub Center 4 5.6 2 4.7 1 1.5 7 3.9 7 2.6
NGO/Trust 1 1.4 1 0.6 1 0.4
Hospital/Clinic
Private Ayush 2 2.8 1 14.3 1 2.3 2 4.8 1 1.5 1 2.6 4 2.2 4 4.6 8 3.0
Hospital/Clinic
Private Hospital/ 7 9.9 14 32.6 24 57.1 13 20.0 14 36.8 34 19.0 38 43.7 72 27.1
Clinic
Home 1 2.3 2 4.8 3 4.6 4 2.2 2 2.3 6 2.3
Other 6 8.5 4 9.3 3 7.1 4 6.2 14 7.8 3 3.4 17 6.4
Total 71 100 7 100 43 100 42 100 65 100 38 100 179 100 87 100 266 100
At the time of illness, child having a problem in the chest or a blocked or runny nose
Angul Jharsuguda Sambalpur All Districts
Rural Urban Rural Urban Rural Urban Rural Urban Total
N % N % N % N % N % N % N % N % N %
Chest 31 22.6 3 42.9 6 7.3 15 21.4 15 11.1 4 9.1 52 14.7 22 18.2 74 15.6
Only
Nose 43 31.4 21 25.6 33 47.1 61 45.2 15 34.1 125 35.3 48 39.7 173 36.4
Only
Both 46 33.6 4 57.1 28 34.1 19 27.1 43 31.9 17 38.6 117 33.1 40 33.1 157 33.1
Don‘t 12 8.8 27 32.9 3 4.3 15 11.1 7 15.9 54 15.3 10 8.3 64 13.5
Know
Other 5 3.6 1 0.7 1 2.3 6 1.7 1 0.8 7 1.5
Total 137 100 7 100 6 7.3 15 21.4 135 100 44 100 354 100. 121 100. 475 100
108
NIPI Baseline Report – Orissa
District
Total
Angul Jharsuguda Sambalpur
Rural Urban Rural Urban Rural Urban Rural Urban Total
N % N % N % N % N % N % N % N % N %
Any medicine taken during illness
Yes 109 79.6 7 100 70 85.4 60 85.7 118 87.4 40 90.9 297 83.9 107 88.4 404 85.1
No 28 20.4 12 14.6 10 14.3 17 12.6 4 9.1 57 16.1 14 11.6 71 14.9
Total 137 100 7 100 82 100 70 100 135 100 44 100 354 100 121 100 475 100
Duration of first medicines given after fever
Same Day 35 32.1 4 57.1 22 31.4 25 41.7 39 33.1 12 30.0 96 32.3 41 38.3 137 33.9
Next Day 49 45.0 1 14.3 24 34.3 29 48.3 55 46.6 17 42.5 128 43.1 47 43.9 175 43.3
Two Days After
13 11.9 11 15.7 4 6.7 14 11.9 3 7.5 38 12.8 7 6.5 45 11.1
Fever
Three Days After
4 3.7 2 28.6 5 7.1 4 3.4 1 2.5 13 4.4 3 2.8 16 4.0
Fever
Four Or More Days
5 4.6 1 1.4 2 1.7 2 5.0 8 2.7 2 1.9 10 2.5
After Fever
Don‘t Know 3 2.8 7 10.0 2 3.3 4 3.4 5 12.5 14 4.7 7 6.5 21 5.2
Total 109 100 7 100 70 100 60 100 118 100 40 100 297 100 107 100 404 100
109
NIPI Baseline Report – Orissa
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)
Children under 3 years breastfed within one hour
54.3 24.9 17.9 24 16 10
of birth (%)
A 18:Indicators of Nutritional Status in Orissa and NIPI Districts, DLHS- RCH, 2002-03
State/District Weight for age Anemia among children Anemia among Pregnant
Women
-3SD1 -2SD2 Mild Moderate 3 Severe Mild Moderate Severe
India 20 49 96 49 44 51 43 3
Orissa 15 43 54 41 3 49 45 4
Anugul 17 46 59 34 5 39 50 7
Jharsuguda 1 10 53 43 3 75 25 0
Sambalpur 21 53 39 54 5 57 39 4
Note: 1. This index is expressed in standard deviation units (SD) from the median of the international reference
population.2 includes children who are below -3 SD from the international reference population median. 3 children
aged 0-71 months. * Based on Districts surveyed in Phase 1 of DLHS-RCH (2002-04)
Source: District Level Household Survey (2003-2004).
110
NIPI Baseline Report – Orissa
Funds Utilised
District Funds Disbursed (Rs)
Amount (Rs) Percent
Anugul 49,262,175 38,323,988 77.8
Sambalpur 48,429,689 26,991,534 55.7
Jharsuguda 23,803,760 15,652,677 65.8
Source: * Financial and Physical progress report (2007-2008)
111
NIPI Baseline Report – Orissa
Item Funds
Funds
utilised Percent
disbursed (Rs)
(Rs)
Training for Programme management. All Block MOs,
Nodal officers of districts, BEE & CDPOs to be trained & 36,000 2,625 7.2
Functionary of Indian Systems of Medicine
Annual expenditure on workshop seminars & trainings of
deployed staff on community mobilization, attitudinal
27,000 5,000 18.5
change in behaviour and financial & other management
evaluation
2 days orientation at district level for O & G specialist, MO
48,610 48610 100
I/c etc
SBA training of SN at DH/PHC/CHC 680,400 319,017 46.9
Cost of setting of centres under SBA training 15,000 - -
IMNCI training
Logistic support 36,500 31,295 85.7
DPMU infrastructure 285,000 285,000 100
EMOC Training 191,100 - -
Orientation training on RKS 17,925 - -
Sub-Total for Training & capacity building 1,337,535 642,937 48.8
JSY 270,000 108,521 40.2
Immunisation 2,753,711 1,911,499 69.4
Source: * Financial and Physical progress report (2007-2008)
112
NIPI Baseline Report – Orissa
Orissa
Personnel In Position On contract
Medical Superintendent 3 0
Specialist (Medicine) 2 0
Specialist (Surgery) 2 1
Obstetrician / Gynecologist 5 0
Pediatrician 4 0
Anesthetist 1 0
Pathologist / Microbiologist 3 0
Radiologist 0 0
Dermatologist / Vanerologist 0 0
Total No. of District hospitals Surveyed 3
113
NIPI Baseline Report – Orissa
Communication Facilities
Orissa
Yes
Telephone facility available in all section 3
Personal Computer available 2
NIC Terminal available at DH 3
Access to internet facility available at DH 3
DH outsourcing data compilation and tabulation work 2
Ambulance 8
Jeep 4
Car 0
Whether CSSD is there in DH 2
Critical care area 3
Integrated counseling and testing center (ICTC) 3
Total No. of District hospitals Surveyed 3
114
NIPI Baseline Report – Orissa
115
NIPI Baseline Report – Orissa
Table A33: Labour Ward And Neo Natal Equipment For Nursery Ward
Labour Ward And Neo Natal Equipment For Nursery Ward
Orissa
Available Functional
Baby incubator 5 2
Phototherapy unit 3 1
Emergency resuscitation kit baby 15 12
Radiant warmer 3 2
Room warmer 4 0
Foetal Doppler 1 1
CTG monitor 0 0
Delivery Kit 10 10
Episiotomy Kit 7 7
Forceps delivery Kit 2 2
Crainotomy 0 0
Vacuum extractor metal 1 1
Silastic vacuum extractor 3 3
Total No. of District hospitals Surveyed 3
116
NIPI Baseline Report – Orissa
Orissa
In On
Position Contract
Is at least one staff nurse/LHV/ANM at CHC available round the clock 3
Gynaecologist 2 1
Anaesthetist 3
Total No. of CHC‘s Surveyed 3
117
NIPI Baseline Report – Orissa
118
NIPI Baseline Report – Orissa
119
NIPI Baseline Report – Orissa
120
NIPI Baseline Report – Orissa
121
NIPI Baseline Report – Orissa
122
NIPI Baseline Report – Orissa
123
NIPI Baseline Report – Orissa
124
NIPI Baseline Report – Orissa
TRAINING
NUMBER OF PHC‟s WHERE TRANING RECEIVED BY ANY MEDICAL OFFICER IN LAST 5 YEARS
Type of Training MO Total
Received Angul Jharsuguda Sambalpur
Training No. No. No. No.
In Last 5
Integrated skill development training for 12 days Year
3 3 3 9
(RCH-1)
Ever 1 2 3
In Last 5
Vector Born Disease Control Programme (VBDCP) Year
4 3 4 11
training
Ever 4 3 2 9
In Last 5
Directly Observed Treatment- Short Course (DOTS) Year
8 5 5 18
training
Ever 0 0 1 1
In Last 5
Year
2 4 1 7
Immunization training
Ever 0 0 2 2
In Last 5
Year
8 6 6 20
NSV-Non Scalpel Vasectomy training
Ever 8 6 6 20
125
NIPI Baseline Report – Orissa
In Last 5
Year
1 1 1 3
MTP- Medical Termination of Pregnancy training
Ever 0 1 0 1
Total No. of PHC‟s Surveyed 8 6 6 20
126
NIPI Baseline Report – Orissa
Table A43: NUMBER OF PHC‟s WHERE SPECIAL SKILL TRANING RECEIVED BY ANY MEDICAL
OFFICER IN THE LAST 5 YEARS
INFRASTRUCTURE
127
NIPI Baseline Report – Orissa
FURNITURE INSTRUMENTS
128
NIPI Baseline Report – Orissa
129
NIPI Baseline Report – Orissa
EQUIPMENTS
Table A49: AVAILABILITY OF EQUIPMENTS AND THEIR FUNCTIONAL STATUS IN SURVEYED PHC‟s
Angul Jharsuguda Sambalpur Total
No. No. No. No.
A. NEWBORN CARE
EQUIPEMENTS
Number of PHC‟s where:
Available 1 0 3 4
Infant resuscitation bag with mask
Functional 1 0 3 4
Available 8 4 6 18
Weighing machine
Functional 8 4 6 18
Available 3 3 3 9
Paddle operated suction machine
Functional 2 3 3 8
Available 2 1 2 5
Mounted lamp with bulb
Functional 2 1 2 5
Available 2 0 3 5
Baby Bassinet
Functional 2 0 3 5
B. OTHER EQUIPMENTS
Number of PHC‟s where:
Available 6 3 4 13
Normal Delivery Kit
Functional 6 3 4 13
Available 2 0 0 2
Equipment for assisted vacuum delivery
Functional 2 0 0 2
Available 4 0 3 7
Equipment for assisted forceps delivery
Functional 3 0 1 4
Equipment for New Born Care and Available 2 0 3 5
Neonatal Resuscitation Functional 2 0 3 5
Standard Surgical Set (for minor Available 7 4 5 16
procedures like episiotomies stitching) Functional 7 4 5 16
Equipment for Manual Vacuum Available 3 0 3 6
Aspiration Functional 3 0 3 6
Available 1 0 0 1
Baby warmer/incubator.
Functional 1 0 0 1
C. COLD CHAIN EQUIPEMENT
Number of PHC‟s where:
Available 2 1 1 4
Ice Lined Refrigerator (Large)
Functional 2 1 1 4
Available 6 5 4 15
Ice Lined Refrigerator (Small)
Functional 6 5 3 14
Available 3 1 2 6
Deep Freezer Large
Functional 3 1 2 6
130
NIPI Baseline Report – Orissa
Available 5 5 2 12
Deep Freezer Small
Functional 5 3 2 10
Available 8 5 6 19
Cold Box
Functional 8 4 5 17
Available 8 5 6 19
Vaccine Carrier
Functional 8 5 6 19
D. REQUIREMENT OF THE LAB
Available 2 0 1 3
Chemical for Hb estimation
Functional 2 0 1 3
Reagent strips for urine albumin Available 3 0 0 3
and urine sugar analysis Functional 3 0 0 3
Plasma Reagin (RPR) test kits for Available 1 0 0 1
syphilis Functional 1 0 0 1
Residual chlorine in drinking water Available 6 6 5 17
testing strips Reagents for Functional 6 6 5 17
peripheral blood smear examination
Available 4 1 2 7
Centrifuge
Functional 3 1 2 6
Available 6 5 5 16
Light Microscope
Functional 5 5 5 15
Available 7 4 4 15
Binocular Microscope
Functional 6 4 4 14
E. Vaccines
Availability 8 5 5 18
BCG Supply 7 5 5 17
regular
Availability 8 5 5 18
DPT Supply 7 5 5 17
regular
Availability 8 5 6 19
OPV Supply 7 5 6 18
regular
Availability 6 5 6 17
Measles Supply 6 5 6 17
regular
Availability 8 5 6 19
DT Supply 7 5 6 18
regular
Availability 8 5 6 19
TT Supply 7 5 6 18
regular
F. PROPHYLACTIC DRUGS
Availability 7 5 6 18
IFA Tablets Supply 6 4 6 16
regular
Availability 5 6 6 17
Vitamin A Solution Supply 4 5 6 15
regular
Availability 7 6 6 19
ORS Packets Supply 6 5 6 17
regular
Availability 6 5 6 17
Contrimaxazole Supply 5 4 6 15
regular
Total No. of PHC‟s Surveyed 8 6 6 20
131
NIPI Baseline Report – Orissa
Availability 1 0 4 5
Kit A Drugs (sub-centre)
Functional 1 0 4 5
Availability 2 0 4 6
Kit B Drugs (sub-centre)
Functional 2 0 4 6
Availability 1 0 2 3
Kit C Equipments (sub-centre)
Functional 1 0 2 3
Availability 2 0 1 3
Kit D Equipments (PHC)
Functional 2 0 1 3
Kit of Essential obstetric care drugs Availability 1 1 3 5
(PHC) Functional 1 1 3 5
Total No. of PHC‟s Surveyed 8 6 6 20
SERVICES
132
NIPI Baseline Report – Orissa
133
NIPI Baseline Report – Orissa
134
NIPI Baseline Report – Orissa
FUNCTIONAL-B.P. Instrument
Yes 13 56.5 15 75.0 23 82.1 51 71.8
AVAILABLE-Stethoscope
Yes 14 46.7 20 66.7 26 86.7 60 66.7
FUNCTIONAL-Stethoscope
Yes 7 50.0 18 90.0 23 88.5 48 80.0
135
NIPI Baseline Report – Orissa
District Total
Angul Jharsuguda Sambalpur
Equipment N % N % N % N %
AVAILABLE-Weighing machine
(adult) 26 86.7 22 73.3 29 96.7 77 85.6
Yes
FUNCTIONAL-Weighing
machine (adult) 22 84.6 20 90.9 27 93.1 69 89.6
Yes
AVAILABLE-Weighing machine
(infant) 25 83.3 19 63.3 27 90.0 71 78.9
Yes
FUNCTIONAL-Weighing
machine (infant) 24 96.0 17 89.5 26 96.3 67 94.4
Yes
AVAILABLE-Hemoglobin meter
Yes 6 20.0 8 26.7 13 43.3 27 30.0
FUNCTIONAL-Hemoglobin
Meter 3 50.0 5 62.5 6 46.2 14 51.9
Yes
AVAILABLE-Fetus scope
16 53.3 15 50.0 22 73.3 53 58.9
Yes
FUNCTIONAL-Fetus
Scope 15 93.8 14 93.3 18 81.8 47 88.7
Yes
AVAILABLE-SIMS Speculum
Yes 23 76.7 21 70.0 28 93.3 72 80.0
FUNCTIONAL-SIMS Speculum
Yes 23 100 21 100 27 96.4 71 98.6
AVAILABLE-Vaccine Carrier
Yes 30 100 30 100 30 100 90 100
FUNCTIONAL-Vaccine Carrier
Yes 30 100 30 100 30 100 90 100
136
NIPI Baseline Report – Orissa
District Total
Angul Jharsuguda Sambalpur
Other Service at Sub center level N % N % N % N %
Does any doctor visit the Sub-center at least
25 83.3 26 86.7 25 83.3 76 84.4
once in a month
Is the day and time of this visit fixed 4 16.0 5 19.2 7 28.0 16 21.1
Are the residents of the village aware of the
timings of the doctor's visit 14 56.0 16 61.5 9 36.0 39 51.3
137
NIPI Baseline Report – Orissa
District Total
Angul Jharsuguda Sambalpur
N % N % N % N %
Have you prepared the Sub-Center plan for
26 86.7 25 83.3 29 96.7 80 88.9
this year
Registers 30 100 29 96.7 30 100 89 98.9
Reports 30 100 29 96.7 30 100 89 98.9
Immunization Card 30 100 26 86.7 30 100 86 95.6
Anc Card 30 100 29 96.7 30 100 89 98.9
Any Other 5 16.7 7 23.3 6 20.0 18 20.0
Training of traditional/Skilled birth
attendants and ASHA 26 86.7 30 100 30 100 86 95.6
Table A59: Maternal and Newborn Deaths in the sub center area
138