Document Type : Original Article
Authors
- . Madhu Gupta
- . Madhur Verma 1
- . Krishna Chaudhary 2
- . MD. Abu Bashar 3
- . Chering Bhag
- . Rajesh Kumar
1 Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, India
2 Civil Hospital (Sector 45), Chandigarh Administration, Chandigarh, India
3 Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
Abstract
BACKGROUND: To ascertain the effectiveness of a collaborative model between the Department
of Community Medicine and state health department to improve MCH outcomes among the urban
poor in Chandigarh.
MATERIALS AND METHODS: A quasi‑experimental study was conducted from 2011–12 to 2015–16
in the intervention and control areas. A collaboration was established between the state health
department and the Department of Community Medicine of an autonomous institute. The intervention
and control areas were mainly inhabited by the poor migrant population. Critical elements of an efficient
collaboration such as the early engagement of partners, clearly stated purpose with common goals,
effective communication, and no financial conflict were implemented in the intervention area. MCH
program’s implementation was strengthened through supportive supervision, enhanced community
engagement, male partner involvement, tracking of high‑risk pregnant women, and identification of
problem families. Trend analysis of MCH indicators was done. The difference‑in‑difference (DID)
analysis was done to measure the net effect of the intervention.
RESULTS: All the MCH indicators improved significantly in the intervention area compared to the
control area (P < 0.05). DID analysis depicted a net increase in the early registration of pregnancies
by 18%, tetanus toxoid immunization by 9.2%, and fully immunized children by 8.6%. There was also
an improvement in the maternal mortality ratio by 121.1 points, infant mortality rate by 2.2 points,
and neonatal mortality rate by 2.6 points in the intervention area.
CONCLUSION: An innovative, collaborative model between the state health department and the
Department of Community Medicine effectively improved the MCH outcomes in Chandigarh.
Keywords
Right to health : International Development Law Organization.
Geneva, Switzerland; 2017.
2. Kriesel W. Intersectorial action for health. A cornerstone
for health‑for‑all in the twenty‑first century. Report of the
International Conference. Vol 51, World Health Statistics
Quarterly. Halifax, Nova Scotia, Canada, 1997.
3. Adeleye OA, Ofili AN. Strengthening intersectoral collaboration
for primary health care in developing countries: Can the
health sector play broader roles? J Environ Public Health
2010;2010:272896.
4. Gupta M, Bosma H, Angeli F, Kaur M, Chakrapani V, Rana M,
et al. A mixed methods study on evaluating the performance of
a multi‑strategy national health program to reduce maternal and
child health disparities in Haryana, India. BMC Public Health
2017;17:698.
5. Government of India. National Urban Health Mission. :
Framework For Implementation. New Delhi, 2013.
6. United Nations Human Settlements Programme. The Challenge
of Slums; Global Report on Human Settlements 2003. London
and Sterling, VA, 2003.
7. Rangarajan C. Rangarajan Report on Poverty. Press Information
Bureau. 2014. Available from: http://pib.nic.in/newsite/
PrintRelease.aspx?relid=108291. [Last accessed on 2019 Jul 03].
8. Arokiasamy P, Jain K, Goli S, Pradhan J. Health inequalities
among urban children in India: A comparative assessment
of Empowered Action Group (EAG) and South Indian
states Environmental medicine: Social and medical aspects
View project Assessing Inequity, and Impoverishment in
Healthcare Expenditure in India View project. Artic J Biosoc Sci
2013;45:167‑85.
9. Fotso JC, Ezeh AC, Madise NJ, Ciera J. Progress towards the child
mortality millennium development goal in urban sub‑Saharan
Africa: The dynamics of population growth, immunization, and
access to clean water. BMC Public Health 2007;7:218.
10. HuX, Cook S, Salazar MA. Internal migration and health in China.
Lancet 2008;372:1717–9.
11. Urban health Division. Meeting the health challenges of Urban
Population especially the urban poor. New Delhi; 2008. p. 159.
Available from: http://www.uhrc.in/downloads/Reports/
NUHM‑Draft.pdf. [Last accessed on 2022 Apr 30].
12. Ministry of Health and Family Welfare (Government of
India). National Urban Health Mission: Orientation Module
for Planners, Implementers and Partners. 2013. Available
from: https://nhm.gov.in/images/pdf/NUHM/Orientation_
module_for_planners_implementers_and_partners.pdf. [Last
accessed on 2019 Apr 15].
13. Storm I, den Hertog F, van Oers H, Schuit AJ. How to improve
collaboration between the public health sector and other
policy sectors to reduce health inequalities?‑A study in sixteen
municipalities in the Netherlands. Int J Equity Health 2016;15:97.
14. World Health Organization. The urban Health Crisis; Strategies
for health for all in the face of rapid urbanization. Report of the
Technical Discussions at the Forty‑fourth World Health Assembly.
Geneva, Switzerland, 1993. Available from: https://apps.who.
int/iris/handle/10665/37434. [Last accessed on 2022 Apr 30].
15. Bhore committee, 1946| National Health Portal Of India. Available
from: https://www.nhp.gov.in/bhore‑committee‑1946_pg. [Last
accessed on 2019 Apr 15].
16. NongkynrihB, AnandK, KusumaYS, Rai SK, MisraP, GoswamiK.
Linking undergraduate medical education to primary health care.
Indian J Public Heal 2008;52:28–32.
17. Zodpey S, Negandhi H, Sharma K. How can departments of
community medicine shape the future of Public Health Education
in India? Indian J Public Health 2010;54:184.
18. Kumar R. Clinical practice in community medicine: Challenges
and opportunities. Indian J Community Med 2017;42:131.
19. Devadasan N, Ghosh S, Nandraj S, Sundararaman T. Monitoring
and Evaluating Progress towards Universal Health Coverage in
India. PLoS Med 2014;11:e1001697.
20. OpenStreetMap. Available from: https://www.openstreetmap.
org/#map=14/30.6980/76.7788&layers=N. [Last accessed on
2019 Aug 01].
21. International Institute of Population Sciences (IIPS). District Level
Household & Facility Survey (2012‑13). Available from: http://
rchiips.org/. [Last accessed on 2021 Jan 11].
22. International Institute of Population Sciences (IIPS). National
Family Health Survey‑IV (2015‑16). Available from: http://
rchiips.org/nfhs/. [Last accessed on 2021 Jan 11].
23. Lal S. Scenario of post graduate medical education in community
medicine in India. Indian J Community Med 2005;25:56–61.
24. Garg R, Gupta S. Are we really producing public health
experts in India? Need for a paradigm shift in postgraduate
teaching in community medicine. Indian J Community Med
2011;36:93.
25. Shewade H, Jeyashree K, Chinnakali P. Reviving community
medicine in India: The need to perform our primary role. Int J
Med Public Heal 2014;4:29.
26. Pandav CS. Role of faculty of medical colleges in national health
policy and program development. Indian J Community Med
2010;35:3–6.
27. Medical Council of India. List of College Teaching MBBS | MCI
India. 2019. Available from: https://www.mciindia.org/
CMS/information‑desk/for‑students‑to‑study‑in‑india/
list‑of‑college‑teaching‑mbbs. [Last accessed on 2019 Apr 15].
28. K e y E l e m e n t 6 : C o l l a b o r a t e A c r o s s S e c t o r s a n d
Levels | C a n a d i a n B e s t P r a c t i c e s P o r t a l ‑ C B P P .
Available from: http://cbpp‑pcpe.phac‑aspc.gc.ca/
population‑health‑approach‑organizing‑framework/
key‑element‑6‑collaborate‑sectors‑levels/. [Last accessed on
2019 Apr 15].
29. Mittelmark MB, Hunt MK, Heath GW, Schmid TL. Realistic
outcomes: Lessons from community‑based research and
demonstration programs for the prevention of cardiovascular
diseases. J Public Health Policy 1993;14:437–62.
30. Aggarwal A, Gupta R, Das D, Dhakar A, Sharma G, Anand H,
et al. An alternative approach for supportive supervision and
skill measurements of health workers for integrated management
of neonatal and childhood illnesses program in 10 districts of
Haryana. Indian J Community Med 2018;43:40.
31. Plough A, Olafson F. Implementing the Boston Healthy Start
Initiative: A case study of community empowerment and public
health. Health Educ Q 1994;21:221–34.
32. Paine‑Andrews A, Harris KJ, Fisher JL, Lewis RK, Williams EL,
Fawcett SB, et al. Effects of a replication of a multicomponent
model for preventing adolescent pregnancy in three Kansas
communities. Fam Plann Perspect 1999;31:182–9.
33. Prybil L, Scutchfield FD, Mays GP. Improving Community Health
through Hospital- Public Health Collaboration : Insights and
Lessons learned from successful partnerships [Internet]. Health
management and Policy faculty book. 2014 [cited 2022 May 9]. p.
1–110. Available from: https://uknowledge.uky.edu/hsm_book.
34. Gupta M, Tripathy JP, Jamir L, Sarwa A, Sinha S, Bhag C.
Improving quality of home‑based postnatal care by microteaching
of multipurpose workers in rural and urban slum areas of
Chandigarh, India: A pilot study. Adv Med Educ Pract 2017;8:1–8.
35. Abadie A. Semiparametric Difference‑in‑Differences Estimators.
Vol. 72, The Review of Economic Studies. Oxford University Press;
2005. p. 1–19.
36. Crown WH. Propensity‑score matching in economic analyses:
Comparison with regression models, instrumental variables,
residual inclusion, differences‑in‑differences, and decomposition methods. Appl Health Econ Health Policy 2014;12:7–18.
37. Wing C, Simon K, Bello‑Gomez RA. Designing difference
in difference studies: Best Practices for Public Health Policy
Research. Vol. 39, Annual Review of Public Health. Annual
Reviews Inc.; 2018. p. 453–69.
38. Kaur J, Kaur M, Webster J, Kumar R. Protocol for a cluster
randomised controlled trial on information technology‑enabled
nutrition intervention among urban adults in Chandigarh (India):
SMART eating trial. Glob Health Action 2018;11:1419738.
)