School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Health and Family Welfare, National Rural Health Mission, Haryana, Panchkula, India.
Matern Child Health J. 2019 Aug;23(8):1025-1035. doi: 10.1007/s10995-019-02733-4.
Introduction India aims to achieve universal health coverage, with a focus on equitable delivery of services. There is significant evidence on extent of inequities by income status, gender and caste. In this paper, we report geographic inequities in coverage of reproductive, maternal and child health (MCH) services in Haryana state of India. Methods Cross-sectional data on utilization of maternal, child health and family planning services were collected from 12,191 women who had delivered a child in the last one year, 10314 women with 12-23 months old child, and 45864 eligible couples across all districts in Haryana state. Service coverage was assessed based on eight indicators - 6 for maternal health, one for child health and one for family planning. Inter- and intra-district inequalities were compared based on four and three indicators respectively. Results Difference in coverage of full ante-natal care, full immunization and contraceptive prevalence rate between districts performing best and worst was found to be 54%, 65% and 63% respectively. More than one-thirds of the sub-centres (SCs) in Panchkula, Ambala, Gurgaon and Mewat districts had their ante-natal care coverage less than 50% of the respective district average. Similarly, a significant proportion of SCs in Mewat, Panipat and Hisar districts had full immunization rate below 50% of the district average. Conclusion Widespread inter- and intra-district inequities in utilization of MCH services exist. A comprehensive geographical targeting to identify poor performing districts, community development blocks and SCs could result in significant equity gains, besides contributing to quick achievement of sustainable development goals.
简介 印度旨在实现全民健康覆盖，注重公平提供服务。收入状况、性别和种姓方面存在大量不平等程度的证据。本文报告了印度哈里亚纳邦生殖、孕产妇和儿童健康（MCH）服务覆盖的地理不平等情况。
方法 从过去一年中分娩过孩子的 12191 名妇女、10314 名 12-23 个月大孩子的妇女和哈里亚纳邦所有地区的 45864 对符合条件的夫妇中收集了利用孕产妇、儿童健康和计划生育服务的横断面数据。根据 6 项孕产妇健康指标、1 项儿童健康指标和 1 项计划生育指标评估服务覆盖情况。根据四个和三个指标分别比较了地区间和地区内的不平等。
结果 发现表现最好和最差的地区之间，完全产前护理、完全免疫和避孕普及率的覆盖率差异分别为 54%、65%和 63%。潘奇克拉、安巴拉、古尔冈和梅瓦特地区的三分之一以上的基层医疗中心（SCs）的产前护理覆盖率低于各自地区的平均水平。同样，在梅瓦特、潘尼帕特和哈里亚纳地区，相当比例的 SCs 的完全免疫率低于地区平均水平的 50%。
结论 MCH 服务的利用存在广泛的地区间和地区内的不平等。全面的地理定位以确定表现不佳的地区、社区发展区块和 SCs，可以在实现可持续发展目标方面取得重大公平收益，同时也有助于快速实现。
