Table 1 Joint display of quantitative and qualitative findings regarding extent of implementation and effectiveness of NRHM’s plans in Haryana

A. NRHM’s plans

Qualitative findings

Budget utilization Rate (%)

(2012–13)

Implementation

Status

Health System Strengthening

113.5 ^a

Full

 Patient transport service/referral services

115^a

Full

• Free availability of ambulance service

• linked to increase in institutional delivery

• Issues with its maintenance

• late arrivals to the homes

• Inadequate number of vehicles

 Infrastructure development and strengthening

33.3

Mid level Partial

• Well equipped clean health centers in rural areas available

• No waiting halls for patients

 Human resources

110^a

Full

• Acute shortage of manpower especially specialist,

• contractual staff available but quality of contractual staff is an issue,

• salary of contractual staff not at par with regular staff,

• negative attitude of doctors,

• specialists not evenly distributed with in the state

 Drugs and logistics

170^a

Full

• Free availability of medicines in health centers in rural areas

• quality is an issue; stock out of situations

 Mobile medical units

0

None

• non functional mobile medical units

• non availability of doctors

• limited awareness in the villages

Communitization

121.5^a

Full

 Accredited Female Health Activist

133.3^a

Full

• Community Mobilizer

• Well known in the villages, has good rapport with the women, especially decision makers (mother in laws)

• Role in immunization of children and pregnant women, institutional delivery

• Generating awareness about NRHM schemes & importance of institutional delivery

• Calls free ambulance and accompanies the families to the hospital for delivery

• Insufficient in number

• Educational qualification has a bearing on their recruitment

 Village health nutrition and sanitation committees

49

Mid level Partial

• Immunization sessions held on village health and nutrition days

• Mother’s meetings also held on these days; known popularly as village health ‘mela’

• Not held regularly

• Members are not involved in planning

 Village health and nutrition days

0

None

• Less awareness among mothers and community members

• Village head would ask for bribe for utilizing the funds

• Funds remain unutilized

Maternal health care strategies

58.33

Mid level Partial

  Janani Suraksha Yojna

80

High level Partial

• Linked with increase in institutional delivery

• Delay in payments due to administrative reasons like opening of bank accounts, proofs required to get the benefits

• Lack of knowledge among mothers about this scheme

  Janani Shishu Suraksha Karyakaram

50

Mid level Partial

• Linked with increased institutional delivery

• Free diet during hospital stay available

• Lack of adequate manpower

Child health care strategies

91.47

High level Partial

 Facility based new born care

31.3

Mid level Partial

• New born referred for treatment to government hospitals from private health facilities as government new born facilities are better

 Integrated management of childhood illnesses

37.5

Mid level Partial

• Trained staff available

• Community lack trust on government facilities for treatment of sick children so do not visit health facilities in villages for treatment

• Lack of supervision

• Poor implementation due to shifting of focus on implementing home based post natal care

 Immunization

106^a

Full

• Lack of sufficient auxiliary nurse midwives

• Cultural barrier are there for immunization of children especially in district Mewat

• Fear of injections

• Accredited social health activists act as an catalyst in acceptance of immunization

B. Effectiveness of NRHM plans in reducing MCH disparities

P value ^b

Statistical significance

Qualitative Findings

 Geographical inequality between urban and rural areas

0.00

Significant decline

• Increase in antenatal registrations in rural areas

• More villagers utilizing services than urban people due to NRHM.

• Awareness has improved and medicines are available in villages however facilities are still more in cities.

 Socioeconomic inequality between rich and poor

0.00

Significant decline

• Availability of free ambulances, medicines, diet during hospital stay for the poor.

• Food security in general would reduce this.

 Gender inequality between male and female child

0.00

Significant decline

• NRHM has no scheme for targeting gender inequality

• Small size of the families and increased educational status has led to the changes in gender inequality

• Gender inequality is less seen in Mewat district