The National Rural health Mission created 24X7 Primary Health Centres in order to provide basic emergency and obstetric services to women. The current study looked into how far the above NRHM objective has been met.
Our study used the case methodology based on the WHO framework for providing safe care as a benchmark. Our resource constraints limited our study to examine the working of only three 24x7 PHCs; one each from an urban, semi-rural, and a rural block of a high focus district in a large Indian State. These blocks were selected purposefully based on geographical terrain and general socio-economic profile. Data sources were statistics from the district and block health offices, a checklist to assess supplies and equipment for childbirth and newborn care in the PHCs, and eleven in-depth interviews with Block Health Officers, PHC medical officers, and nurse-midwives.
Our study showed that the urban PHC attracted more women than the rural and semi-urban PHCs. Reasons for preferring the urban PHC were due to easy access, staff presence and availability of medicines and drugs. An active female worker who stays close to the urban PHC has been very successful in getting women to the PHC. The major reasons for non-utilization in the rural block include geographically difficult area, and the tradition of home deliveries, while the relatively low utilization of the semi-urban PHC is due to presence of private practitioners nearby. Our study also showed that women prefer to go to private practitioners since JSY (Janani Suraksha Yojana) maternity benefits are available for institutional deliveries in public or private facilities, and therefore 24 X 7 PHCs were not an added attraction if private facilities are available nearby. Monitoring at various levels needs to be strengthened to improve the effective service delivery in public health facilities.
Our observations are from a sample of three 24/7 PHCs in a high focus district, and hence cannot be generalized.