NATIONAL RURAL HEALTH MISSION (NRHM) AND CHANGES IN MATERNAL AND CHILD HEALTH CARE: AN EVALUATIVE STUDY IN RAJASTHAN

1. Assistant Research Officer, National Institute of Health and Family Welfare, New Delhi-110067. 2. Professor, School of Extension and Development Studies, IGNOU, New Delhi-110068. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 20 May 2020 Final Accepted: 24 June 2020 Published: July 2020


ISSN: 2320-5407
Int. J. Adv. Res. 8(07), 1010-1017 1011 79%). The state-subsidized demand-side financial like Janani Sishu Suraksha Karyakaram JSSK-which allows all pregnant women delivering in public health intuitions to free transport and no-expansive delivery. The government has put in substansive efforts to facilitate positive engagement between public and privete helath care providers. Campaigns such as the Pradhan Mantri Surakshit Matritva Abhiyan have been introduced with great impact, allowing women access to antenatal check-ups, obstetric gynecologists and to track high-risk pregnancies-exactly what is needed to make further gains and achieve the SDG targets.
The maternal health care (MCH) comprises three important types of care: care during pregnancy called ante-natal care, care during delivery called natal-care and care after delivery known as post-natal care. Many maternal deaths take place in rural areas of Bihar, Uttar Pradesh, Odisha, Madhya Pradesh and Rajasthan because of poor access to quality maternal health care facilities in rural areas. One of the objectives of NRHM programme is to improve the MCH care and prevent maternal mortalities. The Government of India and different state governments are striving hard to improve the health and well-being of their population. In April, 2005, the nation has launched National Rural Health Mission in order to strengthen the delivery of primary health care services for the improvement of health status of rural population. The mission's major objectives include (i) Facilitating increased access and utilisation of quality health services by all; (ii) Reducing child and maternal mortality;(iii) Universalising access to public services for food and nutrition, sanitation and hygiene and to public health services with emphasis on services addressing women's and children's health and universal immunisation; (iv) Improving access to integrated comprehensive primary health care;(vi) Seeing a concomitant reduction in infant mortality rate (IMR), maternal mortality rate (MMR) and total fertility rate (TFR). Prasad et al. (2013), in their paper "Addressing the Social Determinants of Health through Health System Strengthening and Inter-Sectoral Convergence: The Case of the Indian National Rural Health Mission", have noted that at the turn of the 21st century, India was plagued by significant rural-urban, inter-state and inter-district inequities in health. For example, in 2004, the infant mortality rate (IMR) was 24 points higher in rural areas compared to urban areas. To address these inequities, to strengthen the rural health system (a major determinant of health in itself) and to facilitate action on other determinants of health, India launched the National Rural Health

Methodology:-
The study is based on the primary data collected from more than 160 households of 08 villages in Tonk district of Rajasthan, the Tonk district is a less advanced district. The one advance and one backward PHC were selected from the block. The villages were selected randomly from the list of villages available in the block. The primary data of 1012 district Tonk is comparison from secondary data gathered from the various sources like; NHFS-4, DLHS-3 of state Rajasthan.

Discussion:-Maternal Health Care:
The maternal health care (MCH) comprises three important types of care: care during pregnancy called ante-natal care, care during delivery called natal-care and care after delivery known as post-natal care. Many maternal deaths take place in rural areas of Bihar, Uttar Pradesh, Odisha, Madhya Pradesh and Rajasthan because of poor access to quality maternal health care facilities in rural areas. One of the objectives of NRHM programme is to improve the MCH care and prevent maternal mortalities. Tables

NRHM and Child Immunisation:
Immunisation of children against preventive diseases is an essential component of child health care. Although, through various health care programme interventions, the immunisation status of children is improving, yet the status of immunization in children in rural areas is still low, particularly in the health laggard states. A great deal of endeavour is required to raise the immunisation status of children especially in 0-2 year's age group to check infant mortality. Table-1.5 presents an analysis of immunisation status of children in 0-2 years.      Table-1.7 shows that in the Tonk district maternal mortality is high than the state, 223 women's in Tonk district and 208 women's in Rajasthan state died as a consequence of delivery. However, infant mortality is a cause of concern as the IMR is 66 and 59 in Tonk and Rajasthan respectively. Rajasthan has improved significantly on its maternal and child survival indicators in the last 10 years between 2005-06 and 2015-16.
The main reasons for the death of children in the Tonk districts, lack of ANC, medical negligence, observance of traditional faiths, and lack of health education, lack of food and nutrition and unknown causes of death. In over all Rajasthan most reasons for the death of children are prematurity or low birth weight, neonatal infections, and birth asphyxia or trauma. Most of the Infant Mortality Rates (IMR) is caused by low birth weight.