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National Seminar On Reproductive & Child Health and Population Dynamics One of the many important activities undertaken by the institute, as a part of its golden jubilee celebrations, was to organize a three day national seminar from 6-8 March, 2006 at the India Habitat Centre, New Delhi. Prof P.N. Mari Bhat, Director, IIPS extended a warm welcome to the honourable Secretary, Ministry of Health and the delegates. He presented an overview of institute’s activities, its contribution in training demographers in the Asian region, in undertaking several large-scale national surveys and the fact that it is currently celebrating the golden jubilee year. He stated that the main objective of the seminar is to disseminate the findings of both large-scale surveys and the variety of research undertaken by the institute to a large audience of policy makers, funding agencies and researchers. What follows is a brief report of the proceedings of the seminar. The Director also hosted an official dinner at the Habitat Centre for the participants and other invitees. Under the overall guidance of Prof. P.N. Mari Bhat, the seminar was organized by a team of four faculty members namely, Prof. M. Guruswamy, Dr. Usha Ram, Dr. Chander Shekhar and Dr.S.K. Mohanty. What follows is the chief rapporteur’s report of the proceedings of the seminar March 6:
The honourable Health Secretary released several IIPS research reports and
CDs containing DLHS data. Delivering the keynote address, he observed: He pointed out that health assets and resource utilization are critical, this is highest in the southern states but not elsewhere in the country. Therefore, he felt that studies should be undertaken on health system efficiency and how to maximize it. He urged the academic community, especially IIPS, to focus 50 percent of studies on emerging issues that are of great policy relevance rather than repeating studies on old themes. Following this, the first main technical session on District Level Household Survey 2002-04 was held. It was chaired by Prof. Ashish Bose. Referring to the observation made by the Secretary while inaugurating the seminar, he suggested that findings of IIPS studies could be presented to the parliament’s consultative committee on Health. Dr. F. Ram presenting the results of DLHS underscored that the main objective of the survey was to provide data at the district level on indicators of ANC, child immunization, safe deliveries, CPR and unmet need for contraception and knowledge of RTI/STI with particular attention to assessment of equity, outreach, etc. The importance of DLHS data lay in the fact that it is mainly used for programme planning, and less for research, although in Round 2 data on background and birth history were also collected. The results of DLHS were presented for 593 districts covered in 2002-04, with a target of 1,000 sample households per district. About 6 lakh households were covered. It has been a massive exercise, done with financial assistance from the Ministry of Health and Family Welfare. About three-fourths of the women have had contact with health personnel and about half the women had at least three ANC checks. But, such a contact with the health worker has not enabled them to obtain other health services. Only a little above 20 percent had delivered in medical institutions, 41 percent have had safe delivery and 44 percent of children had full immunization. Utilization of services is much lower among the rural, illiterate, SC/ST and among the poor. Progress among them is also very slow. Interstate differences and socioeconomic differences are still very high. Between the two rounds, 1996 and 2001, full immunization coverage shows a drop, utilization is low and drop out is high. In EAG states, most women go for services to the private sector (60 percent) because of the possibility of poor quality of services in government health centres. The extent of no vaccination is as high as 45 percent in Bihar. Severe anaemia prevalence is 3 percent and moderate anaemia prevalence is 36 percent for pregnant women. Condom use remains low even in high HIV prevalence states. The chairperson remarked that DLHS is more useful than the NFHS, though some aspects are complicated or controversial. The discussion on DLHS presentation was mainly on:
It was pointed out that cultural factors may be important determinants of low coverage of institutional deliveries than ANC and child immunization. The second technical session on the facility survey and two other studies on quality of care was chaired by Shri A.R Nanda, Executive Director, Population Foundation of India. The findings of the health facility survey, being first of its kind, were presented by Dr. Balram Paswan. Data were collected on both urban and rural health infrastructure facilities on four domains of (availability of) staff, supply, equipment and training. The proportion of FRUs (First Referral Units) having adequate health infrastructure facilities ranged from 95 percent in Kerala to 25 percent in EAG states; 67 percent in Kerala and just 10 percent in Chattisgarh have adequate staff with the average of 36 percent for India. Sixty eight percent of FRUs have adequate equipment. The second presentation (by Dr. Chander Shekhar) on evaluation of Urban Health Posts and Urban Family Welfare Centres outlined the need for increasing staff, infrastructure to improve the health of the urban poor. The third presentation, the follow-up study of NFHS-2 sample on quality of care with reference to family planning in four states of Bihar, Jharkhand, Maharashtra and Tamil Nadu, proceeded to examine the issue of whether quality of care is related to utilization of services. It suggested that the two are indeed related but the extent of relationship varied amongst the four states. The discussion focused on:
March 7:
The study on incentives and disincentives presented by Dr. L. Ladu Singh suggested that most rural folks and leaders were of the view that the incentive schemes of the government for promotion of small family norm need to be continued. The chairperson remarked that apathy of health personnel remains a major obstacle in service delivery and its promotion. The fourth technical session had four presentations on evaluation and intervention related studies on RTI, STI and HIV/AIDS, with Prof. Leela Visaria in the Chair. The findings of the Charca project, a baseline study of young women who are vulnerable to STI/HIV due to low level of awareness about STI/HIV prevention practices and lack of control over their own sexuality were presented by Dr. S.K. Singh. He stated that culturally appropriate interventions have to be developed to address the issues of capacity building of younger women to build awareness and ensuring their reproductive and sexual rights. The paper on evaluation of targeted intervention for HIV/AIDS in Maharashtra by Dr. Usha Ram suggested that effective programme outreach accompanied with good quality STD services and peer lead intervention are key factors in the success of any targeted intervention irrespective of the target groups /study subjects. The findings of the project on male sexual concerns and prevention of HIV/STD in Mumbai demonstrated that ‘narrative intervention’ model is the best means to address men’s culturally-based sexual health problems and to attract men for the treatment of STIs and to promote HIV risk reduction behaviors. It showed that private, non-allopathic AYUSH practitioners can be oriented to play an effective role in addressing sexual health problems. In the fifth technical session chaired by Prof. K. Srinivasan, the findings of the study on health system performance (World Health Survey) in terms of burden of disease, health financing and health system responsiveness were discussed. Data on several new indicators of population health such as self-reported state of health on various domains, health system responsiveness and health financing were presented. In the survey people have rated the country’s health system performance as good but not very good or excellent. The data on most indicators have important implications as a base for health policy and for establishing a regular evidence base. The discussion centered on the comparability of the data with other data sources such as the NSS. The second presentation was on assessment of the very high prevalence of gall bladder diseases in the Gangetic region of Bihar and Uttar Pradesh using low cost sonography technique. The study confirmed the high prevalence, and suggested dietary habits, use of fertilizers and chemicals in the water as possible causes. The policy implication from this study is that evidence of any hidden epidemic can be assessed with low cost measure of sonography and necessary intervention can be planned. Prof. P. P. Talwar chaired the sixth session where findings of two studies on ageing, one on voluntary retirement scheme in Mumbai (Dr. A. P. Desphande) and the other on living arrangement of the elderly in Maharashtra (Dr. H. C. Srivastava) were discussed. The VRS scheme that was started with the objective of generating employment opportunity to youth and to provide support to the elderly does not seem to have achieved its goals because a majority of the study population could not save the money received as VRS remuneration. The chairman remarked that the study results should be further analysed to know why some were happy with their decision to go for VRS while others were not. The study on quality of life of elderly (60 + population) in Ratnagiri district in Maharashtra showed that 80 percent of the elderly are staying with their sons’ families as they valued the support from the family and their community. Very few of the elderly showed interest to stay in old-age homes. Participants wanted to know why Ratnagiri district was chosen and how the results compare with that of NSS.
March 8:
The paper on returns from fertility decline among uneducated women in India demonstrated evidence from an analysis of NFHS-2 data on the substantial positive benefits to women’s health and their children (ANC, CI, NM, IM, CM) and their contribution to national development in terms of poverty reduction, infant mortality, women’s work participation, SDP growth and human development. The discussion centered on the immediate policy implications of the programme. The paper on health and social consequences of childlessness of women in Andhra Pradesh called for the need to include the component of counseling and advice to childless couples in RCH programme. Prof. S. Parasuraman, Director, TISS, Mumbai chaired the final technical session. Findings of three projects were presented in this session. Dr. K. Gupta presented findings of a survey on migration, health and employment situation in Greater Mumbai City. In-migration rates from the survey are higher than that of census estimates. Discussion on this paper was focused on policy implication of greater influx of people into Mumbai. The chairperson remarked that the slower agricultural growth and the lack of employment in rural sector are leading the influx and the social composition of the city is rapidly changing and studies should be done to study its impact. The presentation by Dr. D.A. Nagdeve on population, poverty and the environment based on secondary data analysis suggested greater deterioration of urban environment due to rural population influx where again poverty and rural environmental degradation is forcing people to the city. The discussion centered around the technical solutions to urban environmental problems such as motor vehicles run on LPG, metro rail projects and rainwater harvesting. The third presentation by Dr. S. K. Mohanty on the progress and prospects of achieving millennium development goals highlighted the state inequalities in achieving the MDGs with respect to poverty, school enrolment and infant mortality. In several states (e.g south), the progress is faster. However, in poorer states of Orissa, Madhya Pradesh etc, the progress is dismal and the required rate of progress is far slower than the required rate. The chairman opined that MDGs are political rhetoric of developed nations and advised the author instead to look at goals set the Indian government and planning commission. Prof. Asish Bose chaired the concluding session of the meeting. In this session, Dr. P.Arokiasamy presented the Rapporteur’s report on the proceedings of the conference. It was followed by a panel discussion on Future Research Directions. Prof. K.Srinivasan, Prof. T. K. Roy, Dr. Venkata Ramana, IAS, (Commissioner, Family Welfare, AP), Prof. P. M. Kulkarni, Prof. Arvind Pandey, Prof. S. C. Gulati, Prof. Narayan Das, Dr. M. E. Khan and Mr. K. D. Maiti participated in the discussion. The panelists urged that IIPS should strive for a balance between large-scale surveys and smaller studies, qualitative versus quantitative/methodological studies and policy-oriented studies versus studies to improve knowledge base. Programme managers should be consulted before taking up studies, and findings should be disseminated in a simple language among different interest groups. Attempts should also be made to publish the research in peer-reviewed journals. It was felt that there is need to improve the managerial capacity of those undertaking larger surveys. The seminar ended with Dr. Usha Ram proposing a vote of thanks.
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