Utilization of ICDS scheme in children one to six years of age in a rural block of central India

The evaluation of nutritional and immunization services was undertaken in the rural ICDS block Sanwer (Madhya Pradesh) where the project is functioning from last 3 years. A door to door survey was conducted in 1993 in six Anganwadi areas in ICDS block and five randomly selected matched non ICDS rural area served as controls. There were a total of 709 children in ICDS and 500 in non ICDS block in 1-6 years age group. The difference was not statistically significant for nutritional status in the two blocks, but a remarkably better immunization status (p < 0.005) was observed in non ICDS block. The coverage for DPT (3 doses), and measles vaccination in ICDS block was 79.57% and 45.7%, respectively, while in non ICDS block it was 94.4% and 62.03%, respectively. It seems the ICDS scheme is under utilized by the community and requires immediate attention by the health authorities.

Integrating leprosy control into primary health care: the experience in Ghana

Integration of leprosy control into primary health care is the most comprehensive and permanent system of delivering care to leprosy patients. But so far only a few countries have adopted this approach, largely on account of a fear of failure. Over the past decade Ghana has developed a model approach towards the transition from a vertical to an integrated programme. The highlights of our approach included the development of the leprosy service as part of the overall development of the health service, increasing capacity building for leprosy control at the district and subdistrict levels as well as the establishment of a regular and effective monitoring to identify and correct operational problems early. This paper describes the principles behind the integration, the strategies adopted and how they were implemented. It also includes the achievements made as well as the problems that were encountered and how they were solved.

Controlling schistosomiasis: the cost-effectiveness of alternative delivery strategies

Sustainable schistosomiasis control cannot be based on large-scale vertical treatment strategies in most endemic countries, yet little is known about the costs and effectiveness of more affordable options. This paper presents calculations of the cost-effectiveness of two forms of chemotherapy targeted at school-children and compares them with chemotherapy integrated into the routine activities of the primary health care system. The focus is on Schistosoma haematobium. Economic and epidemiological data are taken from the Kilombero District of Tanzania. The paper also develops a framework for possible use by programme managers to evaluate similar options in different epidemiological settings. The results suggest that all three options are more affordable and sustainable than the vertical strategies for which cost data are available in the literature. Passive testing and treatment through primary health facilities proved the most effective and cost-effective option given the screening and compliance rates observed in the Kilombero District.

Reproductive health and AIDS-related services for women: how well are they integrated?

To explore the relationship between human immunodeficiency virus (HIV) and AIDS services and reproductive health services, a survey was undertaken in 1994 of 30 health care facilities that are grantees under Title IIIb of the Ryan White Comprehensive AIDS Resource Emergency Act, 19 family planning clinics that offer at least some HIV services, and two family planning agencies that are also grantees under Title IIIb. The Title IIIb providers and the family planning agencies offer similar sets of services, but they tend to view reproductive health and HIV and STD services as distinctly different categories. Eliminating the perceptual distinctions between these services and viewing reproductive health services as key components of HIV and AIDS prevention could result in a more integrated system of helping women with HIV infection or AIDS as well as those at risk of HIV infection.

Involving women

I am a primary health care (PHC) coordinator working with the May Day Rural project, a local NGO involved in integrated approaches and programs with rural communities in the Ga District of the Greater-Accra region in Ghana. When we talk about the community development approach we must first and foremost recognize that we are talking about women, because in the developing world frequent childbirths mean that her burden of mortality is higher than a man's; her workload is extremely heavy--whether in gardening, farming, other household duties, caring for the sick, or the rearing of children; she has a key role in PHC and community development, because men are always looking for greener pastures elsewhere, leaving the women behind. Women's concerns are critical in most health care projects and women and children are their main beneficiaries. Why not include women in the management team, project design, implementation and evaluation processes? That is what the May Day Rural project is practicing, encouraging women's participation and creating a relationship of trust.