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The involvement of CHWs in the state of UP has a long history since the 70s and currently it is the key strategy to percolate primary health care to the masses through the Front-Line Workers like the Accredited Social Health Activists (ASHA) and the Angan Wadi Workers (AWW). The current lot of CHWs in UP are the ASHAs who are the daughters-in-law of a family that resides in the same community that they serve as the grassroots health worker since 2005 when the NRHM was introduced in the EAG states. UP is one such Empowered Action Group (EAG) state. The current study explores some of the crucial variables of the Ante Natal Care (ANC) status and the role of health personnel in these ANC components provided to the Recently Delivered Women (RDW) or mothers in four districts of UP. From the catchment area of each ASHA, two RDWs were selected who had a child in the age group of 3 to 6 months. Through this profile, the ANC components of RDWs, health care worker’s visit profile to the RDWs, reasons for not availing ANC by RDWs and the average number of contacts of health workers with the RDWs are reflected upon to give a picture that represents the entire state of UP.
The relevance of the study assumes significance as data on the details of home visits for ANCs of recently delivered mothers are not available even in large scale surveys like National Family Health Survey 4 done in 2015-16. The percentage of women covered for the four ANCs are given but not for any health worker that also includes ASHA. The current study also gives the average number of contacts by the workers with the RDWs.
A total of four districts of Uttar Pradesh were selected purposively for the study and the data collection was conducted in the villages of the respective districts with the help of a pre-tested structured interview schedule with both close-ended and open-ended questions. In addition, in-depth interviews were also conducted amongst the RDWs and a total 500 respondents had participated in the study.
The results showed that almost all the RDWs in the four districts had come in contact with ASHA or any health personnel during their pregnancy. On the other hand, the all- important abdominal check-up which tracks the foetal growth was advised to few RDWs in all the 4 districts. Again, in all the districts, the health personnel had not prioritized the dietary practices of mothers in their advice to mothers during contact with mothers. They had also not advised them to take supplements during pregnancy. During contacts, besides the routine work, providing the need-based care and support was very critical but this component was also not addressed by the health personnel in all the 4 districts.
Further, on analysis of the reasons for not coming in contact with health personnel, the results showed that in Gonda district, the health personnel were not tracking all the pregnant women for ANC in their 1st trimester and were delaying the ANC putting the mothers at risk. Among the role of health personnel, it was seen that they were providing 3 ANCs having tracked all the pregnant women in Banda and Barabanki but that was not the case in Gonda and Saharanpur. Analysis of the type of health personnel showed that ASHA was the frontline provider making more contacts with the RDWs followed by the ANMs in all the 4 districts. The number of contacts with the private doctor in Gonda district was the maximum and this showed that the ASHAs in Gonda were not covering all the pregnant women.