Maternal health care: impact of training supervision and community education.

A representative rural population of about 100000 was selected for the study. The activities were undertaken in Pune district in the areas covered by three primary health centers (PHCs) in the Phase I area and by 2 PHCs in the Phase II area over a period of five years starting in 1986. The medical officers of the PHC and staff of the District Training Team (DTT) were trained at the Regional Health and Family Welfare Training Center and the King Edward Memorial Hospital (KEM) Pune. The maternal and child health care (MCH) training lasted two days and consisted of classroom lectures demonstrations and discussions. PHC and sub-center health personnel were trained by the research team and by the DTT at the headquarters of the PHCs using slides on MCH services training modules health education guidelines and a model for demonstrating childbirth. A team of one research officer and two medical social workers contacted village leaders about the high risk approach in MCH and gave lectures to women on the physiology of conception and pregnancy risks during visits to the villages once a month. Substantial improvement occurred in antenatal registration immunization against tetanus and referrals. Record-keeping had also improved and data registration on blood samples taken from antenatal cases for hemoglobin estimation increased to 40% in 1990 (no record in 1986); height and weight to 50% (not done in 1986); detection of high risk pregnant women to 42% (not done in 1986); and weighing of babies within 24 hours from 23% in 1986 to 46% in 1990. About 55% of the referred cases used the services at hospitals and health centers via a referral system established in August 1988. The focus was shifted in April 1990 from Phase I area (taken over by the district health organization) to Phase II area. Continual improved MCH care services demonstrated that the training of health personnel and community education can significantly improve services as well as increase their utilization.