Assessment of health care facilities for maternal and child health care at Bal Mahila chikitsalyas in Lucknow district, India

A facility based survey was conducted from Oct 2011 to March 2012 at six Bal Mahila Chikitsalyas (BMCs) in Lucknow district. It was a cross section study. All the BMCs, work as first referral units (FRUs) was included in the study. Assessment was done on the basis of availability of infrastructure, human resources and medical equipments. Functional electric Generator facility was available in 33.3% of BMCs. Availability of functional ambulance was in only 16.7 percent of BMCs. Blood transfusion and caesarean services were available in only 33.3% of BMCs. About 50% of BMCs had regular paediatrician and obstetricians. In 66.7% of BMCs regular anaesthetics or MO trained in LSAS were present. BMCs (50%) had medical officers (MO’s) who were trained in integrated management of neonatal and childhood infection (IMNCI) and two BMCs (33.3%) had MO’s trained in emergency obstetric care (EmOC). Radiant warmers were found in all the BMCs, but functional in only three (50.0%). Only two (33.3%) centres had functional phototherapy unit. In hypertensive drug, four BMCs (66.7%) had Nifedipine and Methyl Dopa. In Emergency drugs like adrenaline and aminophylline were available in 33.3% and 100.0% of BMCs. Calcium gluconate was found only in two (33.3%) of the BMCs. Vitamin K was available only one (16.7%) BMC.


Methodology
The facility based survey was conducted from Oct 2011 to March 2012. There are eight Bal Mahila Chikitsalyas (BMCs) in Lucknow district. Out of eight Bal Mahila Chickitsalyas, six work as first referral units (FRUs). Bal Mahila Chickitsalyas especially have been developed for the maternal and child care services. For the assessment of available health services six Bal Mahila Chickitsalyas (work as FRUs) were included in the present study. For assessment of facilities for maternal care and neonatal care, predesigned schedule (on the bases of Facility based Integrated Management of Neonatal and Childhood Infection training module 10 and Indian Public Health Standard 11 ) was developed. Assessment was done on the basis of availability of infrastructure, human resources and medical equipments with respect of prevailing norms.
The definition of FRU includes the following three components 12 a. Essential Obstetric Care b. Provision of Blood Storage Unit c. New Born Care Services The consent was taken from the medical superintendent of each Bal Mahila Chikitsalyas. Interview was taken from medical superintendent, medical officer, OT in charge and nurses.

Data analysis
Data was tabulated on Microsoft Excel Sheet and analyzed by using the software SPSS, version 17.0. Frequency distributions were calculated for all variables.

Abstract
A facility based survey was conducted from Oct 2011 to March 2012 at six Bal Mahila Chikitsalyas (BMCs) in Lucknow district. It was a cross section study. All the BMCs, work as first referral units (FRUs) was included in the study. Assessment was done on the basis of availability of infrastructure, human resources and medical equipments. Functional electric Generator facility was available in 33.3% of BMCs. Availability of functional ambulance was in only 16.7 percent of BMCs. Blood transfusion and caesarean services were available in only 33.3% of BMCs. About 50% of BMCs had regular paediatrician and obstetricians. In 66.7% of BMCs regular anaesthetics or MO trained in LSAS were present. BMCs (50%) had medical officers (MO's) who were trained in integrated management of neonatal and childhood infection (IMNCI) and two BMCs (33.3%) had MO's trained in emergency obstetric care (EmOC). Radiant warmers were found in all the BMCs, but functional in only three (50.0%). Only two (33.3%) centres had functional phototherapy unit. In hypertensive drug, four BMCs (66.7%) had Nifedipine and Methyl Dopa. In Emergency drugs like adrenaline and aminophylline were available in 33.3% and 100.0% of BMCs. Calcium gluconate was found only in two (33.3%) of the BMCs. Vitamin K was available only one (16.7%) BMC. Key words: Health care facilities'; maternal health; child health; Bal Mahila Chikitsalyas; Urban health.

Discussion
According to Indian Public Health Standard (IPHS) blood transfusion services and caesarean services should be available at each FRU. For the cold chain maintenance each centre should have functional electric generator. But in this study out of six, only two (33.3%) BMCs had such facility. Out of six BMCs, only one had found ambulance/ transport facility however it is recommended by IPHS that each unit (BMCs) accepting neonatal and sick child referrals should have, or have access to, an appropriately staffed and equipped transport service.
According to IPHS, paediatrician should be posted at each FRU and will be in charge of the Stabilization Unit. Regular Obstetrician and Anaesthetics/ Trained in LSAS should be available at each FRU for operative procedure. Training of the Doctors and Nurses posted at Stabilization Unit will undergo Facility based care training. In our study it was found that about half of BMCs had difficiency of specialist. Some medical officers (MO's) were trained in integrated management of neonatal and childhood infection (IMNCI) and emergency obstetric care (EmOC).
The availability of medical equipments was found deficient, according to IPHS radiant warmer and phototherapy unit should be available at all the centres. In this study functional radian warmer was present half of the health facilities and only two BMCs had functional phototherapy unit. According to IPHS, Antibiotics, Nifedipine, Methyl Dopa, Magnesium sulphate, Adrenaline, Calcium gluconate and Vit K should be available at all the centres. In this study some centres had deficiency of drugs. According to another study, in rural area, in PHCs infrastructure, equipment, trained health staffs were defect 13 .

Conclusion
The facilities available for the maternal and child health care at the Bal Mahila Chikitsalyas were unsatisfactory in comparison to prevailing standards (IPHS). For the better care of the urban patients strengthening of these health facilities are required.