A coordinated approach to children's health in India: progress report after five years (1975-1980)

The success of an experiment in a coordinated approach to children's health care in India in 33 community blocks led to its expansion to a national programme covering 150 community blocks by 1980. The Integrated Child Development Services (ICDS) scheme has also been successful as a national programme. Acceptance of immunisation and nutrition intervention schemes and improvement in nutritional status were significantly higher in the community served through the integrated approach than in the community receiving health, nutrition, and education services separately. Favourable impact of ICDS services was proportionally better in the first year than in the fourth year of the service. The Government of India has declared it a programme of national importance to expand and cover 913 of the 5011 community blocks and 87 urban slum areas by 1985.

A reexamination of integrated population activities

The term integrated population activities came into style at the World Population Conference at Bucharest in 1974, where it was used to refer to national planning that recognizes the integral role of population in development, the use of socioeconomic change to solve a nation's population problem, or the implementation of population activities along with health or agricultural projects. In this paper, Laurel Files calls for a more precise definition of the word integrated and the use of different terminology for other types of coordinating activities. She argues that integrated is meaningful only when it refers to planning or implementation of population activities by several ministries, or to the combination of population activities with related services. Beyond restricting the definition, Files calls into question the habit of appending integrated onto population activities as a kind of halo. "Unintegrated" family planning does not deserve a pejorative connotation, for in some situations it may be more effective than integrated family planning.

The relative impacts of vertical and integrated FP/MCH programs in rural Nepal

The objectives of this analysis were to assess the probable impacts of vertical and integrated FP/MCH programs on family planning (knowledge, use, and intentions to use), family size preferences, fertility, and mortality (child and infant). The following discussion summarizes and draws conclusions regarding the results of this investigation. The vertical program showed a greater impact on knowledge of family planning than the integrated program. Increases in knowledge between 1975 and 1978 while controlling for social and demographic variables were greater in the vertical than the integrated areas. Multiple classification analysis at both household and village levels showed that the vertical program was a better predictor of knowledge and changes in knowledge than the integrated program. In addition, the vertical program showed consistently higher proportions of women with awareness of family planning among those segments of the population that could have the greatest impact on fertility reduction in the future--namely, the younger women who are either childless or just beginning their childbearing and those with husbands who have little or no education. Neither the vertical nor the integrated FP/MCH program showed an impact on current use or ever use of family planning. The very low levels and changes in levels of these factors between the programs showed almost no difference throughout the selected demographic and socioeconomic groups. In both program areas the proportions of ever use and current use increased substantially with the number of living sons, exceeding 14 percent and 10 percent, respectively, among women with three or more sons. There were virtually no family planning users or ever users among women with no sons. This appears to indicate that "son preference" (documented in the Nepal Fertility Survey) is an important factor affecting the incidence of family planning practice and may be a formidable obstacle to a substantial reduction in fertility. Family limitation generally may not be taken seriously until a couple has produced the desired number of sons. Hence, until the value of sons (perhaps as sources of labor, financial support and security in old age, and as performers of funeral rites for fathers) can be altered it is unlikely that a reduction in fertility beyond certain levels could occur. The vertical program showed a slightly greater impact on future intentions to use family planning than the integrated program.(ABSTRACT TRUNCATED AT 400 WORDS)

The demographic impact of the family planning--health services project in Matlab, Bangladesh

This paper evaluates the demographic impact of the Family Planning-Health Services Project in Matlab Thana of rural Bangladesh. The project was begun by the International Centre for Diarrhoeal Disease Research, Bangladesh in October 1977. Contraceptive services--including pills, condoms, IUDs, sterilization, and injectables--are supplemented by oral rehydration, tetanus toxoid, and other services. About 33 percent of eligible couples are using contraception. Impact is evaluated by direct measurement of birth rates in the treatment and comparison areas. An overall fertility decline of about 25 percent is observed, concentrated among older women. The impact is two-to-three times that of an earlier project that included fewer methods and used lesser trained workers. The study shows that intensive family planning efforts can affect fertility in the absence of socioeconomic changes.

Socio-economic profile and performance of CHVs in Gujarat: implications for selection and support

What type of person should be selected as Community Health Volunteer (CHV) has been a matter of debate. This study relates socio-economic characteristics--age, sex, marital status, education, caste, organisation membership and landownership--with performance on direct patient care, mother and child health, family welfare and environmental sanitation. The paper further suggests strategies for selection, training and support in case of CHVs whose performance is poor.

A coordinated approach to children's health in India

In 1976 a programme which integrated nutritional, health, and educational services for children, mothers, and pregnant women was set up in India, and these services were delivered to the local people mainly through members of their own community. After 21 months the programme achieved improvements in nutritional status of the children that were not attained by decades of many other separate nutritional, health, and educational programmes. Acceptance of immunisation schemes also improved. The programme was first implemented in 33 communities (blocks). Because of its success its gradually being extended to other blocks.