About DLHS

The District Level Household & Facility Survey is one of the largest ever demography & health survey carried out in India, with a sample a size of about seven lakh household covering all the districts of the country. The ministry of Health & Family Welfare (MOHFW), Govt.of India, initiated DLHS in 1997 to provide district level estimates on health indicators to assists policy makers & program administrator in decentralized planning, monitoring & evaluation.

The DLHS-3 which is the third in the series proceeded by DLHS-1 in 1998-99 & DLHS-2 IN 2002-04 is designed to provide estimates on maternal & child health, family planning & other reproductive health services. For the first time, a population linked facility survey has been conducted in DLHS-3.It covers then all the District Hospitals, Community Health Centres, Primary Health Centers & all Sub Centres. Field work in Madhya Pradesh was conducted during Dec 2007 to May 2008, gathering information from 51,419 households.

The state government is repeatedly emphasizing that the women & children are precious assets of the state & so many initiatives have been taken by the department of Public health & Family Welfare & by the Women & Child Department in the state to improve the health status of women & child which is the major thrust area of government planning. But according to DLHS-3 the average percentage of institutional deliveries in the state is only 47.1% & it is only 40.8% in the rural areas of the state. It has increased at a very slow pace with 18.4% increase.

And on the other hand government of Madhya Pradesh is also claiming to raise the percentage of institutional deliveries from 30% in 2005-06 to 55% in 2006-07 & during eleventh plan it went up from 55% to 79% in 2007-08 & further to 82.36% in 2008-09 (up to June 2008) [NRHM, Department of Public Health & Family Welfare; http://www.mp.gov.in/health/nrhm/dy-graph-2008-09.pdf. The total number of institutional deliveries in 2008-09 from April-Nov 2008 is 906869 out of the total deliveries 1166950 registered in the year.

Maternal Health Indicators in DLHS-3

DLHS-3 unearths poor status of institutional deliveries in the state & some districts have very fossy situation. The percentage of institutional deliveries in the Dindori, Sidhi, Mandla & Barwani is less then 30 %.The percentage of institutional delivery in the district Dinodori is 13.1%, Sidhi 23.5%, Mandla 28.5%, Barwani 29.5%. These districts are mainly inhabited by schedule tribes. Dindori has 64.5%, Sidhi 2.9%, Mandla 57.2%, & Barwani 67% ST population. Thus pregnancy is critical & endangered stage in the life of tribal women.

Safe motherhood & safe child birth can be secured by the availability of good quality health services. But unfortunately the number of health institutions, services & manpower system is very far from the required. For example ANC check-ups lead to early detection of complications in pregnancy & thereby ensuring safe deliveries. But the percentage of mothers who had at least 3 ante-natal check-up in 25 districts in the state is less then 40%. In about 14 districts it is even less then 25%. Out of the 48% districts only 8 districts has more 60% institutional deliveries.

The healthcare in rural areas has been developed as a three tier structure based on predetermined population norms. The sub-centre is the most peripheral institution and the first contact point between the primary healthcare system and the community. Primary Health Centres (PHCs) comprise the second tier in rural healthcare structure envisaged to provide integrated curative and preventive healthcare to the rural population with emphasis on preventive and promotive aspects. Community Health Centres (CHC) forming the uppermost tier. For the smooth running of health services the entire three tiers should be loaded with sufficient infrastructure so as to ensure continued services.

Health Institution Indicators – DLHS 3

CHC is the bonding link to PHCs & SHCs & the state has 278 CHCs spread over 48 districts. CHC provides specialist care in medicine, Obstetrics and Gynecology, Surgery and Paediatrics. According to the guidelines of Health institutions all “Assured Services” as envisaged in the CHC should be available, which includes routine and emergency care in Surgery, Medicine, Obstetrics and Gynecology and Paediatrics. The total number of posted Gynecologist in CHCs throughout the state is only 49. It means that only one gynecologist is available per 5 CHCs. This further means that only One Obstetrician/Gynecologist was available for 18507 institutional deliveries among the total 906869 institutional deliveries in first eight months of the year 2008-09 (April-Nov, 08).

Promotion of safe institutional delivery is major focus of CHCs & for that it has the provision of separate labour rooms in the center. Out of 259 CHCs covered in the survey it has been found that it has total 249 labour rooms. This means on an average only less then one labour room is available per CHC which do not meet demand generated under the maternal health schemes. Out of 1142 SHCs, only 459 Sub centers having separate labour room, but most of then are not equipped with essential facilities like blood storage units, ambulance facility etc.

Similarly the status of Primary Health Center is far from satisfactory. The activities of PHC involve curative, preventive, and Family Welfare Services. For 476 PHCs covered the availability of only 405 separate labour rooms is a big question on government efforts to ensure safe deliveries.

Tetanus and sepsis are among the leading causes of maternal and neonatal death and illness in India. To prevent that normal Delivery Kit has been provided to every SHCs, PHCs & CHCs. But it is very surprising that only 418 PHCs are having normal delivery kits up to 2007-08. And 19.74% (total 94) PHCs are having neonatal warmer.

Due to traditional customs & cultural effects women in Madhya Pradesh do not visit the male doctors for ANC check-ups & deliveries. Ignoring these major public opinions prevalent in rural areas only 64 lady medical officers (LMO) are placed so far.

The sub-centres are needed for taking care of basic health, needs of men, women and children. Each sub-centre is manned by one Auxiliary Nurse Midwife (ANM).In the state only 523 ANM trained in integrated management of neonatal and childhood Illnesses (IMNCI) in last 5 years that are not at all enough to prevent high rate of neonatal mortality in the state.

DLHS-3 unearths the grave situation of the Health institution which is the basic key for entrusting safe institutional deliveries. With such a shortfall of health infrastructure & manpower how safe institutional deliveries could be ensured. 

Seema Jain