An Approach for Antenatal Care--论文代写范文精选

51Due论文代写网精选essay代写范文：“An Approach for Antenatal Care ” 产前保健在农村并不是非常普遍的，它需要现场监测和识别特定水平，并及时的采取纠正措施。进行试点测试和定性讨论，为确保产前保健监控，基于社区的项目。这篇医学essay代写范文研究农村卫生培训中心安吉,也是圣雄甘地的野外实习地区。每月监测和操作研究是基于快速定量监控工具，通过发现执行监督贫困地区和整体产前服务覆盖和定性方法。关于孕妇怀孕期间的危险的症状和体征有显著改善，。在三个月期间,整个产前登记改善从253(67%)到327(86.7%)。

Abstract
Background and Objective: Utilization of antenatal care in rural India is far from universal. It requires monitoring and identification of specific needs at field level for timely corrective actions. To pilot test the triangulation of rapid quantitative (Lot Quality Assurance Sampling) and qualitative (Focus Group Discussion) monitoring tools for ensuring antenatal care in a community based program. 

Methods: The present study was undertaken in surrounding 23 villages of Kasturba Rural Health Training Centre (KRHTC), Anji, which is also a field practice area of Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram. The monthly monitoring and action system of the study was based on the rapid quantitative monitoring tool (Lot Quality Assurance Sampling, LQAS)to find out poor performing supervision areas and overall antenatal service coverage and the qualitative methods (Focus group discussions (FGDs), and free listing) for exploring ongoing operational constraints in the processes for timely decision making at program and community level. A trained program supervisor paid house visit to 95 randomly selected pregnant women from 5 supervision areas by using pre-designed and pre-tested questionnaire. For poor performing indicators, semi structured FGDs and free listing exercise were undertaken to identify unmet service needs and reasons for its poor performance. 

Results: Registration of pregnancy within 12 weeks improved from 22.8% to 29.6%. The consumption of 100 or more IFA tablets during pregnancy significantly improved from 6.3% to 17.3%. There was significant improvement in awareness among pregnant women regarding danger signs and symptoms during pregnancy. Over three months period, the overall antenatal registration improved from 253 (67%) to 327 (86.7%). Conclusion: The present field based monitoring and action approach constructively identified the reasons for failures and directed specific collective actions to achieve the targets. 
Key Words: LQAS, Focus group discussion, Monitoring, Antenatal care, Community action

Introduction
Antenatal care (ANC) constitutes screening for health and socioeconomic conditions by skilled providers to detect complications related to pregnancy, providing therapeutic interventions known to be effective; and educating pregnant women about planning for safe birth, emergencies during pregnancy and raises their awareness about the need for care during delivery.1 However, in rural settings of India, due to poverty, illiteracy and late enrollment with service provider, uptake of these services is far from universal even in settings where they are widely available.2 Thus, it requires monitoring and identifying specific needs at field level for timely corrective actions. The experiences with classical monitoring and evaluation approach where the information is collected at peripheral level and analyzed at the central level of organization are not good as data quality is often poor, time consuming and often does not lead to corrective actions.3 The present study pilot tested triangulation of rapid quantitative (Lot Quality Assurance Sampling) and qualitative (Focus Group Discussion) monitoring tools for timely and locally relevant information for decision making and facilitating participatory community actions for ensuring antenatal care in a community based program.

Discussion
The Government of India, under National Rural Health Mission has established Village Health, Nutrition and Sanitation Committee (VHNSC) at village level. The VHNSC has been envisaged to prepare health plan after carrying out health needs assessment and implement and monitor monthly health activities at village level in coordination with government health care providers. An Approach to Monitor and Initiate Community Led Actions for Antenatal Care in Rural India and rapid tool for timely self assessment and need based community actions at primary health care level. 

It ensured non-threatening and transparent supervision of field staff. The adopted monitoring indicators had tangible benefits which in turn provided feedback for sensitization and capacity building of local VCC members on specific health needs. The qualitative and quantitative information bridged the gaps in information needs. It ensured coordination and dialogue between field staff and village people to address unmet needs of poor performing antenatal indicators. Salewicz has also suggested similar requirement of conditions for monitoring tools in strategic management and development process.11 Conventionally, the system of monitoring and evaluation is perceived as donor driven policing function, which is often preoccupied with requirement of ‘success stories’.11 The rigid vertical monitoring systems lack the culture of learning and there is poor emphasis on indigenous knowledge building in project staff which is crucial for identification of intervention strategies. 

In the present study, the participatory methods were used as complementary to LQAS method for exploring and understanding indigenous concerns and reasons for poor performing antenatal indicators. Khandait et al12 and Simpson et al13 found that illiteracy, low socio-economic status, high parity and distance of health centre as the responsible factors for late pregnancy registration among rural Indian women. However, the major two reasons explored in the present study for poor early registration were fear of black magic leading to abortion and not being sure about pregnancy state. The participatory intervention slowly improved early pregnancy registration, along with relatively better uptake of antenatal care and health education on danger signs during pregnancy. In order to develop sense of accountability and ownership, the field staff and VCC members were involved in decision making and implementation of the desired intervention processes. The choice of monitoring tools and methods for the present study was crucial. It was based on better known monitoring tools which undertook a focused and rapid quantitative and qualitative assessment. 

This was required to direct the effective planning and collective actions. There is a growing emphasis that LQAS method which has been successfully used for immunization and growth monitoring should now be mainstreamed for monitoring primary health care programs in developing countries.14,15 LQAS coverage estimates tend to be more precise than estimates obtained using cluster-sampling techniques. Bhattacharya et al have found that participatory monitoring and evaluation approach is a useful tool to improve reproductive health program performance as it was learning based and empowered the target community.16 Noteworthy, National Rural Health Mission (NRHM), also envisioned use of FGDs at Primary Health Centre level under framework of suggested community based monitoring and planning.17 In the present study, the logical sequence of LQAS and participatory methods provided double loop learning, where it was necessary to review and restructure activities related to poor performing indicators. The failure to deliver timely feedback to field workers and community members may lead to poor achievement of targets. 

To summarize, the present field based monitoring and action approach constructively identified the reasons for failures and directed specific collective actions to achieve targets of time bound community based CLICS program. Considering similar organizational and management framework under NRHM, similar approach may be adopted in monitoring and initiating community led actions to improve the performance. The approach proposed in the present small scale research needs to be further tested at a larger scale before it’s up-scaling as a best practice for monitoring and evaluation.（essay代写)

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