One of the factors used to judge the overall development of a country is the status of Mother and Child Health(MCH) services,especially in rural areas.

An effective MCH service can reduce Maternal morbidity,thereby building healthier human resources.MCH services in rural areas need to be wide spread,as they are needed all over,at all times and at affordable costs,In order to provide an effective service,it is now clear that we need to involve the Local self Goverment(PRI's) and other stakeholders. A clear understanding of the services,its problem and constraints is necessary for improvement and this understanding can be the basis of activities such as policy review, advocacy, networking, training and dissemination of information at the various levels of governance, starting at the grassroots.

The Project on Local Self Governments and MCH services study the factors that influence the status of MCH services.Using budget analysis as an instrument of engagement with the local self government,we aim to improve the quality of these services in rural Karnataka.The project focuses in the maternal health issues in particular as the issue tends to get neglected when both maternal and child health issues are studied together.

Project Methodology

• Analysis of budgets related to MCH services at various levels of governance.
• Tracking case studies of select women through pre and antenatal period with focus on nutrition, contact with health services, expenditure and care seeking behaviour.
• Usage of GIS software to analyse accessibility of health services.
• Extensive interaction with SHGs in EWRs on the issue of adequate MCH services in rural areas.

The project coverage is 2 districts in Karnataka with a time frame of 3 years, to be chosen out of 6 shortlisted districts, using specific criteria.

Key Concerns

Accountability

The need for the PRI's to be involved in the provision & monitoring of resources, adequacy and effectiveness of MCH services, PHC / SUBC setups, MCH agenda in PRI's, and EWR's involvement in the health services of rural areas.

Affordability

The cost of getting pre and ante-natal services, private / public expenditure, and care seeking decisions.

Accessibility

The location of PHC's, subcentres, facilities and infrastructure, locational and logistic issues (GIS application), reach of the services interms physial and phychological factors.

Expected Output

• Report the status of MCH services in rural Karnataka in the sample districts.
• Institutional audit with reference to MCH services and Local Self Governments.
• Documentation of user needs, experiences and expectations.
• GIS data, Kannada website on MCH services, dissemination of information.
• Development of content for training and advocacy materials.
• Pointers for policy and advocacy interventions at various levels of governance, including the engagement of local health bodies.
• Evaluations and monitoring of MCH services under the guidance of an Advisory Council that includes experts in the field of MCH.

Key Questions

• How much funding has been allocated for MCH services specifically, rather than for health as a whole, in the budget?
• On what basis is this allocated and is it adequate for providing, atleast the basic facilities and services for safe pregnancies and safe deliveries?
• Has the allocation been actually spent and has it been effective?
• The resposibilty of local self government in providing MCH services through PHCs and subccntres(refer to the 73 rd amendment, 11 th schedule of Functions to be devolved and the Conformity law of Karnataka on the devolution of 29 subjects.)
• An examination of schemes like Suraksha Herige(safe childbirth) and Integrated Child Development Services, in collaboration with MCH personel, SHGs, NGO's, Government officials and Elected representatives to explore in the depth the local situation, problem and potential for improvement of MCH services.