A Descriptive Study on Availability of Skilled Birth Attendants (Nursing Personnel and Health Workers Female) in Peripheral Area of the Union Territory,Chandigarh

http://doi.org/10.33698/NRF0101 Neerja Sharma, Indarjit Walia, Sushma Kumari Saini

Abstract :This descriptive study was conducted in the peripheral areas of the Union Territory, Chandigarh. A total of 212 Government and private health care facilities were visited to ascertain the availability of skilled birth attendants (SBAs). The study revealed that 129 SBAs were available in the peripheral areas but they were not evenly distributed. Major concentration has been found in Mani Majra (30.2%) and Ram Darbar (37.9%), the satellite towns of Chandigarh City where government health institutions were located. The remaining 31.9% SBAs were scattered in 21 villages. In 11 villages only a single SBA was available in each of the Government run Sub-Centres. Majority of the SBAs were having GNM qualifications. None of the private health care facilities employed any SBA. In 12 villages in the peripheral areas of the Union Territory deliveries were being performed by 46 trained and 7 untrained Birth Attendants (Dais). The ratio of SBA to population tremendously varied but was much better where major health institutions were located.

Key words :Skilled Birth Attendants, Availability

Correspondence at : Dr. Neerja Sharma Lecturer Swift College of Nursing Rajpura, Patiala

Introduction

For a mother and her new born a skilled bir th attendant can make the difference between life and death 1. Proper antenatal care helps in providing the women with emotional and practical suppor t, assisting them to deliver healthy babies and promoting birth as a positive experience. When both mother and children survive and thrive, the societies in which they live also prosper 2.Midwifery training, practice and standard setting processes in India have undergone many changes aiming at building an efficient and skilled cadre of bir th attendants since independence3. In the 1970’s and 80’s the training of Traditional Birth Attendants (TBAs) became an integral component of maternal and child health interventions. Many of our programs have incorporated TBA training into our village level efforts simply due to the fact that families are using their services for delivery and there are no alternative health providers willing to be available 24 hours a day, 7 days a week to respond to delivery calls. In remote areas, this situation has not changed significantly. In India there are 142 districts spread out around the country identified by the Ministry of Health and Family Welfare where less than 30% of deliveries are conducted by trained personnel, this includes trained TBAs 4.Until the mid 90’s the term ‘trained’ attendant was commonly used and it included both professional and non-formally trained community based providers of care during pregnancy, child birth and post natal period5. From 1996 onwards the term “skilled” attendant was employed which refers exclusively to people with midwifery skills (for example, doctors, midwives, nurses) who have been trained to proficiency in the skills necessary to manage normal deliveries and diagnose, manage or refer complications.In India each year roughly 30 million women experience pregnancy and 27 million have live birth 6. Life threatening complications can occur in 15% of all bir ths. No matter whether the woman has had four or five ante- natal check ups. It’s just absolutely unpred- ictable7. Women in rural areas are most at risk giving birth without skilled attendance or with a family member or alone. Aggarwal in his study in Varanasi had noted that only one trained dai was available for a population of 16486 and one ANM for 10991 persons8. Another study has highlighted that in less developed regions more than half pregnant women gave birth with the help of an unskilled person and 35% had no contact with the health care system during pregnancy 9.Serious shortages of skilled attendants are common throughout the developing world. As a general target, at least one skilled attendant for every 200 births per year is recommended, but some developing countries have only one skilled attendant per 15,000 births. Shortages are especially severe in rural areas, since health professionals are often concentrated in cities 10. WHO estimates that the number of skilled attendants in the developing countries needs to be increased by at least 3,33,000 11.At present, 7.37 lakh nursing professional who can function as skilled birth attendant have been registered in various state nursing councils in India. It is estimated that only about 40% are in active service and there are about 4 lakh female multipurpose workers of whom nearly 1.5 lakh are working in Government sector12.In India, 48.3% of the total births are conducted by skilled birth attendants, with wide disparity of 75.2% in favour of urbanareas. In addition, regional disparities have also been documented with 98% deliveries being conducted by skilled birth attendant in Kerala as against only 28% in Jharkhand13. In a study conducted in Chandigarh Union Territory, 21% of deliveries in rural and 7% in urban areas were repor tedly not assisted by skilled birth attendants, with this percentage as high as 68% in slums 14.In Chandigarh city 2261 SBA are available at Government as well as Private health care facilities 15. However, the availability of skilled birth attendants in peripheral areas of the Union Territory was not known. This study was conducted to ascer tain the availability of skilled bir th attendants by covering the peripheral areas.

Objective:The study was conducted to find out the availability of skilled bir th attendants (nursing personnel and health workers female) in the peripheral areas of the Union Territory, Chandigarh.

Material and Methods:The study has been conducted in the peripheral areas of the Union Territory, Chandigarh covering 21 villages and 2 satellite towns, namely Mani Majra and Ram Darbar. These areas represent about one third (34.66 sq kms) of the total area of 114 sq. kms of the Union Territory. Only 92120 (10.23%) of a total population of 9,00,635 of the Union Territory reside in the peripheral areas with a literacy rate of 75.6% as against 82.6% in urban area 16.All health care providers at Government as well as private health facilities in the peripheral areas of the Union Territory, Chandigarh were included in the study. Two performa were developed after review of literature and in consultation with experts from the field of nursing and preventive and social medicine. Content validity of the tool was also determined. Information about existing Government as well as private Health Care Facilities in the study area was collected. The data was collected from September to December, 2008 by visiting all the Government and private health care facilities personally. In all 212 health care facilities were visited which provided the information readily. Data was analysed using descriptive and inferential statistics.

Results:A total of 129 SBAs were available in the peripheral areas of the Union Territory, Chandigarh as shown in Table 1.Table 1 shows that major concentration of SBAs has been found in the Hospitals at Mani Majra (30.2%) and Ram Darbar (37.9%), the satellite towns of Chandigarh City having government health institutions. The remaining 31.9% SBAs were scattered in 21 villages. In 11 villages only a single SBA was available in each of the Government run Sub-Centres. None of the private health care facilities employed any SBA. Majority of them i.e. 73 (54.30%) are having GNM qualifications and the rest 56 (43.40%) are MPHW(F)/LHVs. There are only 3 (2.30%) SBAs with B. Sc. Qualifications.Table 1: Distribution of Skilled Birth Attendants in the Peripheral areas of the Union Territory, Chandigarh

 

S. No. Place Staff Nurses/ Nursing Sisters MPHWs (F)/LHVs Total
(a) Hospitals
1.          Air Port Road (ITBP) 4 2 6
2.           Mani Majra 21 18 39
3.          Ram Darbar (ESI) 45** 4 49
(b) Civil Dispensaries
1.           Dadu Majra 0 3 3
2.           Dhanas 1 2 3
3.           Mauli Jagran 0 4 4
(c) Sub-Centres
1. Behlana 0 1 1
2. Daria 0 1 1
3. Hallo Majra 0 1 1
4. Industrial Area 0 1 1
5. Kajheri 0 5 5
6. Khuda Ali Sher* 0 0 0
7. Kaimbala 0 1 1
8. Kishangarh 0 2 2
9. Khuda Jassu 0 1 1
10. Khuda Lahora 0 1 1
11. Maloya 0 2 2
12. Palsora 0 1 1
13. Raipur Khurd 0 1 1
14. Raipur Kalan 0 1 1
15. Sarangpur 0 1 1
(d) Others        
1. Indira Nagar Colony      
  (Urban Health Training Centre) 0 2 2
2. Palsora (Community Outreach) 2*** 0 2
Total   73 56 129

* Khuda Ali Sher is given coverage by Sarangpur MPHW(F) on fixed days

** Includes 2 B. Scs.   ***Includes 1 B. Sc.

Figure 1 also depicts the availability of SBAs in the areas covered in this study. The details of these Health Care Facilities where these SBAs were positioned have been shown in Table 2 which indicated that health care was monopolised by private clinics providing allopathic and ayurvedic services.

Figure 2 shows the distribution of Health Care Facilities at peripheral level in the Union Territory, Chandigarh.

Table 2: Distribution of Health Care Facilities in the peripheral areas of the Union Territory, Chandigarh

S. No. Type of Health Facility n
1. Government Hospitals 02
2. Government Dispensaries 08
3. Government Sub-centres 13
4. Private Hospitals 04
5. Private Clinics 121
6. Private Nursing Homes 04
7. Dental Clinics 11
8. Lab/Diagnostic Centres 05
9. Homeo Clinics 07
10. Ayurvedic Clinics 34
11. Miscellaneous 03
  Total 212

Table 3 shows that there were 54 birth attendants who were self-employed and performing deliveries at the peripheral level. A majority of them, 46 (85%) were Trained Dais and 7 (13%) were Untrained Dais. Only 1 of the birth attendant (about 2%) was qualified as GNM. In Maloya and Ram Darbar 10 self employed birth attendents were practicing. In rest of the places the number ranged from one to seven.Table 3 : Distribution of Self-employed Birth Attendants (Trained and Untrained Dais) at the peripheral level

  1.   Trained Dais Untrained Dais Total
    1.       Daria 1 0 1
    2.       Dadu Majra 4 2 6
    3.       Dhanas 1 1 2+1*
    4.       Hallo Majra 5 0 5
    5.       Kajheri 7 0 7
    6.       Khuda Jassu 2 1 3
    7.       Khuda Lahora 2 3 5
    8.       Maloya 10 0 10
    9.       Mauli Jagran 1 0 1
    10.     Palsora 2 0 2
    11.      Ram Darbar 10 0 10
    12.      Sarangpur 1 0 1
    Total 46 7 53+1*

    No. Location No. of self-employed Birth Attendants

* only 1 SBA self-employed

Figure 3 depicts the availability at peripheral level in the map of Chandigarh.

Table 4 Shows ratio of SBAs to population in peripheral areas of Union Territory, Chandigarh. It is clear from Table 4 that in the peripheral areas the ratio ranges from 1: 568 to 1:65510. The ratio is 1:568 in Ram Darbar satellite town which has ESI Hospital and 1:870 in Mani Majra, another satellite town having a maximum population of 72946 served by a Civil Hospital and a CHC. Maloya has 1: 19735 which is the poorest among the peripheral areas. Peripheral areas do not have equal distribution of SBAs as per population in these areas.

Table 4 : Distribution of Population and Skilled Birth Attendants in Peripheral Areas of Union Territory, Chandigarh

S. No. Location (Rural) No. of SBAs Population Ratio
1. Airport Road 6 – –
2. Behlana 1 5299 1 : 5299
3. Daria 1 7305 1 : 7305
4. Dadu Majra 3 20225 1 : 6742
5. Dhanas 4 16479 1 : 4120
6. Hallo Majra 1 13552 1 : 13552
7. Indira Nagar Colony 2 9645 1 : 4823
8. Industrial Area 1 65510 1 : 65510
9. Kajheri 5 13291 1 : 2658
10. Khuda Alisher* 0 4090 –
11. Kaimbala 1 3411 1 : 3411
12. Kishengarh 2 – –
13. Khuda Jassu 1 1438 1 : 1438
14. Khuda Lahora 1 6489 1 : 6489
15. Maloya 1 19735 1 : 19735
16. Mani Majra 39 72946 1 : 1870
17. Mauli Jagran 4 7174 1 : 1794
18. Makhan Majra 0 – –
19. Palsaura 3 5351 1 : 1784
20. Raipur Khurd 1 3946 1 : 3946
21. Raipur Kalan 1 2661 1 : 2661
22. Ram Darbar 49 27820 1 : 568
23. Sarangpur 1 1738 1 : 1738

* Khuda Alisher is being covered by SBA positioned at Sarangpur Sub-Centre Source (2001) – Statistical Branch, Census Office, Chandigarh (Unpublished)

Discussion:Increasing the proportion of births that take place with a skilled attendant is an internationally agreed health and development goal. Yet shortage of skilled attendants persists throughout the developing world. Coverage by skilled attendants remain low in many countries because of the problems with availability, due to insufficient numbers of skilled attendants and inappropriate deployment existing personnel.The present study was conducted in the peripheral areas of the Union Territory of Chandigarh which has 212 health care facilities including Government and Private hospitals, Sub-Centres and private clinics. According to 2001 Census, the Union Territory had a total population of 9,00,635 including 92120 (10.23%) living in rural areas16. Projecting these figure to 2009, the present population of rural areas is estimated to be 1,25,000. In the present study it has been found that there were a total of 129 SBAs available in the peripheral areas. Thus, the ratio of SBAs to population was 1:969. The availability of SBAs in peripheral areas of the Union Territory, Chandigarh was certainly better than proposed by the International Confederation of Midwives (ICM) and International Federation of Gynecology and Obstetrics (FIGO) which is 1:5000 17. This was in complete contrast to South East Asia and Sub-Saharan Africa where only one SBA was available for every 300,000 people 18.Out of 129 SBAs available in the peripheral areas, 56 MPHW(F)/LHVs were primarily providing skilled care by registering the antenatal cases, ensuring immunization, identifying high risk cases and motivating them for institutional delivery. The remaining SBAs were also providing similar services in addition to their usual bed side services. These SBAs were cornerstones of maternity services in the peripheral areas as they played decisive roles in providing skilled bir th attendance. Malaysia and Sri Lanka have also used services of government employed SBAs extensively to provide outstanding maternity services19. Studies show that the availability of SBAs at the institutional set up does not always guarantee availing services and home deliveries are still preferred by many 20. The latest statistics of NRHM has revealed that 3383 home deliveries have taken place in Chandigarh during 2008-09 21. The person caring for a woman during labour and child birth has greater influence than the place of delivery whether at home or in a health care facility. The present study reveals the presence of 1 SBA, 47 Trained and 7 Untrained Dais providing services independently in peripheral areas of the Union Territory. Experts also believe that the best role for the TBA in skilled attendant strategy is to serve as an advocate for skilled care encouraging women to seek care from skilled birth attendants.

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