La regulación emocional en el contexto de la perspectiva del ciclo vital

HN+

• Exclusive feeding of mothers’ milk to the children.

• Registration at the Anganwadi Centers and utilization of Anganwadi Supplementary nutrition by the lactating mothers

• Facilitation of timely immunization of children by Health Activists, Health Sub- committee, ASHA workers, AWWs and ANCs.

• Nutrition support and health counseling to PNCs in Nutrition Centers

HN • With the exception of nutrition support extended to PNCs in Nutrition Centers, HN _{areas exhibit practices similar to HN+ areas.}

Control

In the absence of regular follow-up of PNCs by health functionaries, immunization of children in Control areas is less than that of HN+ and HN areas. Though PNCs are aware of the place of immunization, they need reminders from health functionaries regarding the times and schedule of immunization of children.

Note: In many cases Vaccination Cards were not available with respondents as they were either misplaced or lost.

7. Recent illness episodes and infant/child/maternal mortality in the community HN+

There were a few cases of infant/child/maternal mortality in the community but the incidence of these cases was small and not enough to draw inferences.

HN Control

8. Awareness of communicable diseases

HN+

The awareness level ranged from moderate to high, owing to the health counseling provided by external trainers and internal health frontline workers. Prevalence rates of diarrhea, malaria TB and was low. There were a few random cases of HIV reported. Though medical care was being availed in case of incidence of diseases, not much emphasis is being placed on prevention of diseases.

HN

The awareness level of communicable diseases ranged from low to moderate. Many of the respondents were unaware of steps needed to prevent communicable diseases such as diarrhea and TB. Respondents had a fair awareness of the AIDS epidemic.

Control

The awareness level of communicable diseases, the ability to distinguish between diseases, and the types of diagnostic tests needed was low. Respondents had a fair awareness of the AIDS epidemic. The general tendency is to seek the assistance of health functionaries in event of any type of ailment. No precautionary steps were being taken for prevention of diseases.

9. Hygiene practices being adopted in the community

HN+

Awareness of hygiene practices was high. This can be attributed to the health training provided by CRPs (internal and external) and health activists. However, implementation of hygiene practices ranged from moderate to high.

HN Awareness of hygiene practices was ranged from moderate to high. However, implementation of hygiene practices ranged from low to moderate.

Control

Awareness of hygiene practices was just moderate. This can be attributed to the fact that there are no special health functionaries available to provide information on hygiene practices and to monitor implementation, besides the AWW. There is ample scope for improvement in implementation of hygiene practices.

10. Sanitation situation in the village

HN+

Most villages lacked proper public sanitary infrastructure and policies for solid and liquid waster disposal systems. Most homes do not have toilets and homes with toilets do not have running water. Homes and streets lack a proper system of solid and liquid waste disposal. It is common to see drains left out into the open giving rise to stagnant pools.

There were a few instances where community sanitation works such as cleaning of overhead water tanks, prevention of water logging near public taps, and sprinkling of waste oil on stagnant water pools to prevent breeding of mosquitoes. Concerted efforts by village organizations in improving the sanitation situation in villages were few and far between.

HN

11. Role of CBOs in promoting healthy behaviour of the people

HN+

The VO and the Health Sub-committee play a major role in setting up and managing the day to day activities of the Nutrition centers. Also, a health agenda has been introduced in each CBO meetings where current health issues are discussed and follow-up action is taken. The VO Office Bearers / Health Sub-committee and SHG leaders are being imparted health training by the Master Trainers, as per the schedule in the training calendar.

HN Same as above.

Control

There is no special focus on health issues by the CBOs. Though health issues are discussed in the VO and SHG meetings, no specific health promotional activities are being taken up.

12. Knowledge of health facilities and services available

HN+

People have a high level of awareness of the health facilities and services available within the village. They have a moderate level of awareness of health facilities and services available at the mandal level, and a limited level of awareness of health facilities and services available at the district level. Generally, the guidance of health functionaries is sought in availing services from health facilities outside the village. HN

Control

13. Satisfaction with the public health facilities / services

HN+ _{In general there has been an increase in the utilization of public health} facilities/services, over the years. By and large, the beneficiaries are satisfied with the current public health facilities/services available. In some cases beneficiaries have reported that the medical care being received in public health facilities as being cursory and in a few cases drugs were reported to be in short supply.

In some cases it has been reported that availing in-patient treatment from public health facilities is as expensive as that of availing the same services from private health facilities, barring bed charges. The practice of availing services of RMPs for general ailments is also prevalent as they are more accessible and affordable. Those who are more solvent prefer services from private health facilities as they feel that get better medical care.

HN

Control

Summary

In the health and nutrition study, the characteristics of HN+ and HN villages were, by and large, similar, in a wide range of issues. However, HN+ villages were relatively better off than HN villages. This can be attributed to the fact that Nutrition Centers function as nodal points for health functionaries to interact with beneficiaries, on a day to day basis. Nutrition Centers in HN+ villages are providing ample opportunities to health functionaries to meet and counsel beneficiaries regarding health care and mobilize

them for availing a range of health services. This has brought about an increase in the knowledge levels of beneficiaries, promoted health seeking behaviour and has resulted in timely and optimal utilization of health services. Also, day to day interaction between the health functionaries and beneficiaries in Nutrition Centers is seen to promote a sense of fraternity and bonding as a community among the health functionaries and beneficiaries

In villages with just HN activities and no Nutrition Centers, health functionaries lack the opportunity to meet beneficiaries in groups, convergent at a point, on a day to day basis. Though HN days and SHG meetings do provide opportunities to meet beneficiaries, the frequency of these meetings is restricted to one or two, in a month. Alternatively, health functionaries have to distribute their time in making home visits and this has a bearing on the frequency of visits and the amount of time that can be spent with the beneficiaries during each visit. This has resulted in a lower level of health awareness and a less than optimal utilization of health services.

Control villages, with relatively fewer health functionaries, do find it difficult to meet the health and nutrition service demands. Here the interaction between front line health functionaries and beneficiaries of health and nutrition services is limited, both in terms of frequency and duration of meetings. This limited interaction between the health functionaries and beneficiaries has resulted in low level of health awareness, less than satisfactory level of health seeking behaviour and only a marginal to moderate level of utilization of health services. Introduction of health and nutrition intervention activities in these areas could bring about the desired changes in the existing health trends.