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Impact of a Multi-Strategy Community Intervention to Reduce Maternal and Child Health Inequalities in India: A Qualitative Study in Haryana

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  • Madhu Gupta
  • Hans Bosma
  • Federica Angeli
  • Manmeet Kaur
  • Venkatesan Chakrapani
  • Monica Rana
  • Onno C P van Schayck

Abstract

A multi-strategy community intervention, known as National Rural Health Mission (NRHM), was implemented in India from 2005 to 2012. By improving the availability of and access to better-quality healthcare, the aim was to reduce maternal and child health (MCH) inequalities. This study was planned to explore the perceptions and beliefs of stakeholders about extent of implementation and effectiveness of NRHM’s health sector plans in improving MCH status and reducing inequalities. A total of 33 in-depth interviews (n = 33) with program managers, community representatives, mothers and 8 focus group discussions (n = 42) with health service providers were conducted from September to December 2013, in Haryana, post NRHM. Using NVivo software (version 9), an inductive applied thematic analysis was done based upon grounded theory, program theory of change and a framework approach. Almost all the participants reported that there was an improvement in overall health infrastructure through an increased availability of accredited social health activists, free ambulance services, and free treatment facilities in rural areas. This had increased the demand and utilization of MCH services, especially for those related to institutional delivery, even by the poor families. Service providers felt that acute shortage of human resources was a major health system level barrier. District-specific individual, community, and socio-political level barriers were also observed. Overall program managers, service providers and community representatives believed that NRHM had a role in improving MCH outcomes and in reduction of geographical and socioeconomic inequalities, through improvement in accessibility, availability and affordability of the MCH services in the rural areas and for the poor. Any reduction in gender-based inequalities, however, was linked to the adoption of small family sizes and an increase in educational levels.

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  • Madhu Gupta & Hans Bosma & Federica Angeli & Manmeet Kaur & Venkatesan Chakrapani & Monica Rana & Onno C P van Schayck, 2017. "Impact of a Multi-Strategy Community Intervention to Reduce Maternal and Child Health Inequalities in India: A Qualitative Study in Haryana," PLOS ONE, Public Library of Science, vol. 12(1), pages 1-23, January.
    • Handle: RePEc:plo:pone00:0170175
    DOI: 10.1371/journal.pone.0170175
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    References listed on IDEAS

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    1. Pathak, Praveen Kumar & Singh, Abhishek, 2011. "Trends in malnutrition among children in India: Growing inequalities across different economic groups," Social Science & Medicine, Elsevier, vol. 73(4), pages 576-585, August.
    2. Madhu Gupta & Federica Angeli & Hans Bosma & Monica Rana & Shankar Prinja & Rajesh Kumar & Onno C P van Schayck, 2016. "Effectiveness of Multiple-Strategy Community Intervention in Reducing Geographical, Socioeconomic and Gender Based Inequalities in Maternal and Child Health Outcomes in Haryana, India," PLOS ONE, Public Library of Science, vol. 11(3), pages 1-13, March.
    3. Abhishek Singh & Saseendran Pallikadavath & Faujdar Ram & Reuben Ogollah, 2012. "Inequalities in Advice Provided by Public Health Workers to Women during Antenatal Sessions in Rural India," PLOS ONE, Public Library of Science, vol. 7(9), pages 1-8, September.
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