Providing Quality Reproductive Health in India

India's population of over 1 billion is still growing by 1.7% per year. Despite improvements in lowering infant and maternal mortality, every year 65 infants die per 1000 live births and some 440 women perish in childbirth per 100,000 live births. Most of these preventable deaths occur in rural villages where trained personnel and supplies are not available. With the contraceptive prevalence rate hovering below 50% for all methods, the government recently abandoned contraceptive targets.

The hallmark of India's new National Population Policy is its emphasis on improving the quality of reproductive health care by working more closely with community based organizations and women's groups. Much remains to be done. A recent National Family Health Survey found that only 13% of women interviewed had received a home visit from a health care worker during the 12 months preceding the survey.

The project has three main objectives:

• Strengthen client's access to quality sexual and reproductive health information and services.
• Improve the ability of service providers to respond more appropriately to informed demand for better quality services.
• Assess the efficacy of interventions aimed at improving client satisfaction.

At the national level two activities have been carried out:

1) Establishment of a working coalition of UN partner agencies - UNFPA, ILO/STEP, UNICEF and WHO oversee and coordinate the project.

2) Improving the quality of care status review study.

At the local level a strategic assessment will:

• Identify existing gaps in quality of reproductive health care from the perspective of both users and providers
• Enhance community mobilization through local councils (Panchayats), women's groups, or other community-based organizations.
• Institute baseline studies at project sites
• Facilitate stakeholder's meeting to help identify strategic interventions
• Orient women's groups to quality of care issues.
• Orient providers (both public and private) on quality of care issues.
• Develop a checklist to assess service quality
• Expand scope of health insurance to include coverage for RH care.
  

What's NEW

The UN team has initiated a series of activities to assess the current situation regarding quality of care and the role of civil society in securing it in both public and private health care settings. Two states have been selected as pilot sites – Gujarat and Haryana.

In Haryana, the Department of Women and Children will be implementing the project. A major focus of community-based activities will be to mobilize women’s groups to work on reproductive health and quality of care issues with the Panchayats -- local village councils mandated to manage local affairs and address development issues, including access to reproductive health. Health care workers in Haryana’s public health system will also be trained on how to provide improved services that meet client’s specific needs.

In Gujarat, the project’s main thrust will be to improve women’s access to quality maternal health care. SEWA (Self-Employed Women’s Association), one of the largest women’s unions in India, will lead awareness efforts among its members about the benefits of good health during pregnancy, so as to increase demand for quality maternal health care. SEWA members, who participate in the organization’s health insurance scheme, will identify providers who are good health care performers and recommend them to other members. Providers in the private sector will be oriented on service quality issues in order to meet increased demand for quality maternal health care.

Both strategies will enable these two states to move further away from quotas and incentives, basic steps for accelerating the implementation of quality reproductive health care systems in the country.