Gupta Madhu, Bosma Hans, Angeli Federica, Kaur Manmeet, Chakrapani Venkatesan, Rana Monica, van Schayck Onno C P
Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Professor of Social Epidemiology, Department of Social Medicine, CAPHRI, Maastricht University, Maastricht, The Netherlands.
PLoS One. 2017 Jan 18;12(1):e0170175. doi: 10.1371/journal.pone.0170175. eCollection 2017.
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.
2005年至2012年期间，印度实施了一项名为“国家农村卫生使命”（NRHM）的多策略社区干预措施。其目的是通过改善优质医疗保健服务的可及性和可获得性，来减少母婴健康（MCH）方面的不平等现象。本研究旨在探讨利益相关者对NRHM卫生部门计划在改善母婴健康状况和减少不平等方面的实施程度和效果的看法与信念。2013年9月至12月，在哈里亚纳邦NRHM实施之后，对项目管理人员、社区代表、母亲进行了共计33次深度访谈（n = 33），并与卫生服务提供者进行了8次焦点小组讨论（n = 42）。使用NVivo软件（版本9），基于扎根理论、变革计划理论和框架方法进行了归纳性应用主题分析。几乎所有参与者都报告称，通过增加经认可的社会健康活动家的数量、提供免费救护车服务以及在农村地区提供免费治疗设施，整体卫生基础设施得到了改善。这增加了母婴健康服务的需求和利用率，即使是贫困家庭对与机构分娩相关服务的需求和利用率也有所提高。服务提供者认为人力资源的严重短缺是卫生系统层面的一个主要障碍。还观察到了特定地区的个人、社区和社会政治层面的障碍。总体而言，项目管理人员、服务提供者和社区代表认为，NRHM通过改善农村地区和贫困人口获得母婴健康服务的可及性、可获得性和可承受性，在改善母婴健康结果以及减少地理和社会经济不平等方面发挥了作用。然而，基于性别的不平等现象的任何减少都与采用小家庭规模和教育水平的提高有关。
