An action plan to assess the current situation of maternal & newborn care at government health facilities in Jharkhand, India

Kumar, Sudesh and Singh, Janet (2007): An action plan to assess the current situation of maternal & newborn care at government health facilities in Jharkhand, India. Forthcoming in:

Abstract

Maternal and child health care especially safe motherhood services are an important factor in the primary health care and are the responsibility of the government and ministry of health. Consolidating and strengthening health network and quality of primary health care is one of the priority issues of the state and the health department for providing good health care and protection to the population.

Since, long government health facilities, in spite of being the main source of health care services for majority of people, especially for those having low income; has very poor condition. Therefore, it’s important to improve the quality of services in the government facility, which can be achieved by stressing on the context of care provided. Situational analyses or facility audit are tools which use various approaches to identify the gaps in the structure and Process of the facility, in order to determine the best intervention to improve the performance.

This study proposes an ‘Action Plan’ to assess the current quality of care in Govt health facilities in Ranchi, Jharkhand concerning Maternal and newborn care. By using Qualitative and quantitative study Methods like Site assessment, exit interview and focused group discussion. The method aims to identify together with major gaps; the entire minor gaps in the health system responsible for maternal and newborn mortality and morbidity that could be solved at the local level without the involvement of additional resources. The results obtained could be used to frame interventions to strengthen Maternal and newborn care system of Jharkhand.

• Item Type: MPRA Paper
• Language: English
• Keywords: Jharkhand Health Policy Development Economics Adivasi Tribal Ranchi Santali Munda Oraon
• Subjects: J - Labor and Demographic Economics > J1 - Demographic Economics > J13 - Fertility ; Family Planning ; Child Care ; Children ; Youth; Z - Other Special Topics > Z1 - Cultural Economics ; Economic Sociology ; Economic Anthropology; I - Health, Education, and Welfare > I3 - Welfare, Well-Being, and Poverty > I31 - General Welfare, Well-Being; I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy ; Regulation ; Public Health; O - Economic Development, Innovation, Technological Change, and Growth > O2 - Development Planning and Policy; Z - Other Special Topics > Z1 - Cultural Economics ; Economic Sociology ; Economic Anthropology > Z13 - Economic Sociology ; Economic Anthropology ; Social and Economic Stratification; I - Health, Education, and Welfare > I1 - Health

References

Abouzahr C: (1993): Maternity Care for all: ORGYN: 4:12-16.

ADDM: (2002): Working Group on Indicators , Program Note: Using UN Process Indicators to assess needs in Emergency Obstetric Services : Bhutan , Camroon and Rajasthan, India. International J. Of Gynaecology and Obstetric: 77: 277-284.

ADDM: (2002): Working Groups on Indicators, Program Note: Using UN Process Indicators to assess the needs in Emergency Obstetric Services: Pakistan, Peru, and Vietnam. International J. of Gynaecology and Obstetrics: 78: 275-282.

Adeyi O, and Morrow R: (1996): Concepts and methods for assessing the quality of essential obstetric care: Int. J. Health Plan. Management: 11:119-134.

Alam N: (2000): Teenage Motherhood and infant Mortality in Bangladesh: maternal age dependent effect of parity one.

Ambruoso D.L; Abbey M. and Hussein J: (2005): Please understand when I Cry out in pain: Women’s account of Maternity Services during Labour and delivery in Ghana: BMC Public Health: 5: 140-51.

Bailey P. and Paxton A: (2002): Program Note: Using UN Process Indicators to assess need in Emergency Obstetric Services. International J. of Gynaecology and Obstetric: 76: 299-305.

Basu S.K: (1994): The state of the Art-Tribal health in India (in) Tribal Health in India: edited by Salil Basu, Manak publications, Delhi: Pages-12-14.

Basu S.K, Jindal A, Kshatriya G.K, et al :(1993): Study for socio-cultural, demographic features, Maternal and Child health Care practices and sexually transmitted diseases in Santhals of Mayurbhanj district, Orissa (Mimeo. NIHFW): New Delhi: 1-6.

Basu S: (2000): Dimensions of Tribal health in India: Health Population Perspect issue: 23: 61-70.

Berg C.G: (1995): Parenatal Care in developing Countries: The world Health Organisation Technical working group on antenatal care. Journal of the American Medical women’s Association: 50: 182-186.

Bernis L. D, Sherratte R.D, AbouZahr C, and Lerberghe V.M: (2003): Skilled attendant for pregnancy, childbirth and postnatal care: Br. Med. Bull: 67: 39-57.

Bertrand JT, Hardee K and Magnani R J (1995), Accessing quality of care and medical barriers in family planning programmes; International family planning perspective, 21:64-69.

Bhatia B.D, Chandra R: (1993): Adolescent Mothers an unprepared Child: India J. Maternal Child Health: 4 :( 3):67-70.

Biernacka J.B, Hanke W :( 2006): The effect of occupational and non occupational Psychosocial stress on the course of pregnancy and its outcome: Med Pr: 57: (3): 281-90.

Borooah V.K: (2004): Gender Bias among Children in India in their diet and immunisation against disease: Soc. sci Med: 58: (9): 1719-31.

Brown L. di prete, et al: (2000): Quality assurance of Health care in developing countries: Quality assurance methodology refinement series (Bethesda, MD: Quality assurance project 2000).

Bruce J: (1990): Fundamental Elements of Quality of care: a simple framework: Stud Fam Plann: 21(2): 61-91.

Bryce J, el Afrifeen S, Pariyo G, Lanata C, Gwatkin D, Habicht J.P, Multi-country Evaluation of IMCI study groups: 2003: Reducing Child Mortality: can public Health deliver? : The Lancet: 362: (9378): 159-164.

Bryce J, Toole MJ, Waldman RJ and Voigt A: (1992): Assessing the health quality of facility- based child survival service: Health Policy Planning. 7:155-163.

Campbell M, Sham ZA: (1995): Sudan: Situational analysis of maternal health in Bara District, North Kordofan. World Health Statistics Quarterly: 48: 60-66.

Campbell O.M.R, Graham W.J :( 1990): Measuring maternal mortality and morbidity: levels and trend. Maternal and child Epidemiology unit publications: 2: London. London school of Hygiene and tropical medicine: 43:246-261.

Campbell O.M.R, Graham W.J: (2006): Strategies for reducing maternal mortality: getting on with what works: The Lancet: 368: 1284-1299.

Carroli G, Rooney C, Villar J: (2001): How effective is antenatal care in preventing maternal mortality and serious morbidity? An overview of the evidences: Pediatric Perinatal Epidemiology :15:1-42.

Cunningham F. G, et al: (1993): Williams Obstetrics, vol.-I 19th edition Norwalk. CT: Appleton and Lange.

Dashora R: (1995): Status of Tribal Girl Child: Soc Change: 25:2-3: 207-16.

Dennis LI, Flynn BC, Martin JB: (1995): Characteristics of pregnant women, utilization, and satisfaction with prenatal services in St. Petersburg, Russia. Public Health Nursing: 12:374-377.

Department of Reproductive Health and Research (DRHR) : (2000):Managing Complications in Pregnancy and Childbirth : a guide for Midwives and Doctors, WHO/RHR/00.7. Integrated management of Pregnancy and childbirth. Geneva: World Health Organisation.

Department of Reproductive Health and Research (DRHR): (2002): The WHO reproductive health library, WHO/RHR/01.1 Vol-5, Geneva: World Health Organisation.

DFID: (2004): Reducing Maternal Deaths: Evidence and Action: page – 1-35.

Director of Census Operation, Jharkhand (DCOJ): (2001b): Census of India 2001, series 21, Jharkhand provincial population totals: paper-2 of 2001: Rural–urban distribution of Population, Patna.

Donabedian A: (2003): An introduction to quality assurance in health care: Oxford University press.

Donabedian A, (1998a): Quality assessment and assurance unit of purpose, diversity of means. Inquiry: 25:173-192.

Donabedian A, (1998b): The quality of care: How can it be assessed? JAMA: 260:1743-8.

Donabedian A,(1979): The quality of medical care; a concept in search of definition: J. Fam. Pract: 9: 277-284.

Donabedian A: (1982): Exploration in quality assessment and monitoring: The criteria and standards of quality; Health Administration Press, Michigan.

Donabedian A: (2003): An introduction to Quality assurance in health care: Oxford University Press.

Elias C: (2006): Can we ensure health is within reach for everyone?: The Lancet: Medicine and creativity: Vol. - 368: S40-S41.

Fauveau V, Blanchent T: (1989): Deaths from injuries and induced abortion among rural Bangladeshi women. : Soc. Sci. Med: 9: 1121- 27.

Filmer D, Hammer J, Pritchett L: (1997): Health Policy in poor countries: weak link in the Chain: World Bank.

Foundation for Research in Health System (FRHS): (2003): Study on availability and accessibility of abortion care: Client perception of quality and access to abortion care in Ranchi, Jharkhand: A report: http://www.frhsindia.org/ActivityReport.htm (accessed on January 14th 2007).

Garner P, Thomson J and Donaldson D: ( 1990): Quality assessment of health facilities in rural Papua New Guinea; Health Policy Planning. 5:49-59.

Ghosalkar A.B: (2006-07): Tribes of India: Ahmadabad, Gujarat, and Anthropological Survey Ministry of Tribal Affairs: by book wise (India) Pvt. Ltd. New Delhi. India. Annual Report (2006-07) www.Tribal.nic.in/finalcontent.pdf

Gilson L : ( 1995): Management and Health care reform in Sub-Saharan Africa: London school of hygiene and tropical medicine: university of London: Soc. Sci. Med: 40: (5): 695-710.

Government of India :( 1949): The constitution of India: New Delhi: Government of India.

Government of India :( 1950): Constitution of India part xvi, special provisions relating to certain classes: New Delhi: Government of India.

Graham W. J, Bell J. S, Bullough C.W.H: (2001): Can skilled attendance at delivary reduce maternal mortality in developing countries? In: de Bouwere V, van Lerberghe W, (eds), Safe Motherhood Strategies: a review of the Evidences: Antwerp: ITG press: Studies in Health Services Organisation and Policy: (17):97-129.

Gupta P.K: (2004): The status of maternal health and child care in newly formed States: Jharkhand, Chhattisgarh, and Uttaranchal of India: District level analysis: Indian Journal of preventive and social medicine: vol. 35:1&2: pages- 46-57.

Gwatkin D.R: (2000): Health inequalities and the health of the poor. What do we know? What can we do? : Bull World Health Organisation: 78: 3-18.

Gwatkin D.R: 2003: How well do health Programme reach the Poor?: The Lancet: 361:540-541.

Haddad S, Fournier P: (1995): Quality, cost and utilization of health services in developing countries: a longitudinal study in Zaire: Soc Sci Med: 40:743–753.

Hardee K, and Gould B.J: (1993): A process for quality improvement in family planning services: International family planning perspectives: 19:147-152.

Harrison K. A: (1997): Maternal Mortality in Nigeria: the real issues: Afr. J Reprod. Health: 1: 7-13.

Hartfield V.J: (1980): Maternal Mortality in Nigeria Compared with Earlier International Experience: International Journal Of gynaecology and Obstetrics: 18: 70-75.

Hibbard L.T: (1978): Complications of Pregnancy and Delivery: In current Obstetric and Gynaecological Diagnosis and Treatment, Lange, ed Los Altos, Calif: R.C.Benson; PP. 664-686.

Hoj L, da Silva D, Hedegaar K, Sandstorm A, Aaby P: (2003): Maternal Mortality, only 42 days? : Br J Obstet and Gynaecol: 110:995-1000.

Horrison A: (1994): Assessing maternal and prenatal health: Tools and methods, the mother care experiences; John Snow Inc., Arlington, USA.

Hotchkiss D: (1998): The trade off between price and quality of services in the Philippines. Social Science and Medicine: 46: 227-42. http://eprints.soton.ac.uk/40965/ accessed on 15th April 2007.

http://wbln0018.worldbank.org/Institutional/Manuals/OpManual.nsf/tocall/0F7D6F3F04DD70398525672C007D08ED?OpenDocument Accessed on 02/04/007.

http://www.un.org/esa/socdev/unpii/documents/PFII%202004%20WS.1%203%20Defination.doc Accessed on 02/04/2007.

Hulton L.A, Matthew Z, Stones W.R: (2000): A Framework for the evaluation of Quality of care in Maternity Services: Southampton, UK, University of Southampton: pp- 40.

Indigenous Peoples Development Plan (IPDP) India :( 2006): Vector Borne Disease

Institute of Medicine: (1990): Medicare: A strategy for Quality assurance. Vol I, Washington D.C, National Academy Press. Pp- 94.

Inter-agency group for safe motherhood.(1998): Every pregnancy faces risk: Ensure skilled attendance at delivery: in Starrs A, Editor . The Safe motherhood action agenda: Priorities for the next decade. Report on the safe Motherhood Technical Consultations, 18-23 October 1997, Colombo, Sri-Lanka, New York: Family Care International; pp25-35.

Islam M.T, Hassain M.M, Islam M.A, Haque Y.A: (2005): Improvement of coverage and utilization of emergency obstetric care services in South western Bangladesh: Int. J. Gynaecol. Obstet: 91(3): 298-305.

Jose M, Paul V, Bhutta Z, Kolinsky M, Soucot A, Walker N, Rajiv B, Fogstad H, and Costello A:(2005): Neonatal Survival : A call for action : The Lancet : 365: 9465: pp 1189-1197.

Journal of Indian States History (JISH): 2001: Vol2: No1, http://www.princelystates.com accessed on 28th Sept 2006.

Jowett M: (2000): Safe Motherhood interventions in Low- income Countries: an Economic justification and evidence of cost effectiveness: Health Policy: 53:201-228

Kamara A: (1992): Health Messages and obstetric first aid for the community: Parer presented at the seventh operations research workshop of the prevention of maternal mortality network Accra, Ghana: May 11-15 1992.

Kay B.J. et al: (1991): "The Bangladesh Women's Health Coalition," Quality/Calidad/Qualité, no. 3 (New York: Population Council, 1991): 1-24, Quoted in Adrienne J. Kols and Jill E. Sherman, "Family Planning Programs: Improving Quality," Population Reports 26, no. 3 (Baltimore: Johns Hopkins University School of Public Health, Population Information Program, 1998).

Khan K.S, Wojdyla D, Say L, Gulmezoglu A.M, Van Look P, :( 2006): WHO systematic review of causes of maternal deaths: Lancet: 367:1066-74.

Kim Y.M, Rimon J, Winnard K, Corso C, Mako I.V, Lawal S, Banaloa S, and Huntingdon D: (1992): Improving the quality of service delivery in Nigeria: Studies in family planning: 23: 118-127.

Kols A.J and Sherman J.E: ( 1998): "Family Planning Programs: Improving Quality," Population Reports 26, no. 3 :Baltimore: Johns Hopkins University School of Public Health, Population Information Program.

Kumar S, Jain A.K., and Bruce J: (1989): Assessing the quality of family planning services in developing countries: Programs division working paper no-2: Population Council, New York.

Kunst A.E, Houweling T: (2001): A Global picture of poor – rich differences in the utilization of delivery care: Studies Health Serv Organ Policy: 17: 297-316.

Kwast B E: (1998): Quality of care in reproductive health program: Concept, assessments, barriers and improvements – An overview; Midwifery: 14:66-73.

Kwast B.E: (1996): Reduction of Maternal and Perinatal Mortality in rural and peri-urban settings: What works?: Eur. J. Obstet. Gynaecol. Reprod. Biol: 69: (1): 47-53.

Lawn J.E; Cousen S; Zupan J: 2005: 4 million Neonatal death: When? Where? Why? : The Lancet: vol - 365: issue 9462: pp 891-900.

Li X.F, Fortney J.A, Kotelchuck M, Glover L.H: (1996): The postpartum period: The key to maternal Mortality. Int. J. Gynaecol. and obstet.: 54:1-10.

Loudon I: (1992): Death in childbirth: an international study of maternal care and maternal mortality 1800-1950. New York: Oxford University Press.

Loudon I: (1992): The transformation of maternal mortality. British Medical Journal: 305:1557-60.

Macinko J, Starfield B, Shi L: (2003): The contribution of Primary care System to health otcomes within organisation for economic co-operation and development (OECD) Countries, 1970-1998. Health Service Research: 38: (3):831-865.

Macintyre K. and Hotchkiss D: (1999): Referral revisited: Community financing schemes and Emergency transport in rural Africa. Social Science and Medicine: 49:1473-1487.

Maine D and Paxton A: (2003): Evidence based strategies for prevention of maternal Mortality, in Evidence –based obstetrics: Editors – R. Johnson and S.Daya: Blackwell Published: Oxford.

Maine D, Rosenfield A: (1999): The safe Motherhood Initiative: Why has it stalled?; Am J Public Health: 89:(4): 480-2.

Maine D, Wardlaw M. T and Ward V.M: (1997): Guidelines for monitoring the availability and use of obstetric services; UNICEF, WHO, UNFPA, New York. Pages 6-110.

Maine, D: (1991); Safe motherhood programs: options and issues. New York: Centre for Population and Family Health, Columbia University.

Maiti S, Unisa S,Agarwal A.k: (2005) : Health care and Health among Tribal women in Jharkhand: A situational Analysis: Stud. Tribals: 3(1):37-46.

Marmot M: (2006) Health in an unequal World: Lancet: 368: 2081-2094.

Maybury –Lewis D: (2002): Indigenous People, ethnic groups and the state: 2nd edition: Boston :Allyn and Bacon; page- 146.

Mc Donagh M, Goodburn E: (2001): Maternal Health and Health sector reforms: Opportunities and challenges: Stud. Health Serv. Organ. Policy: 17:317-385.

McCarthy J, Maine D: (1992): A framework for analyzing the determinants of maternal Mortality. Stud Fam Plann: 23: 23-33.

McCormick M. et al: (2002): Preventing Postpartum haemorrhage in low – resource setting:. International J. of Gynaecology and Obstetrics: 77:267-275.

Measure Evaluation :( 2001): Quick investigation of Quality (QIQ): A user’s guide for monitoring quality of care in family planning: Measure Evaluation Manual Series no-2 (Chapel Hill, NC: Carolina Population centre , university of north Carolina at chapel hill.

Mehrotra S, Jarrett S.W: (2002): Improving basic health service delivery in low – income countries : Voice to the poor: Soc.Sci.Med: 54:( 11) : 1685-1690.

Miller R, Fisher A and Miller K: (1997): The situation analysis approach to assessing family planning and reproductive health services; A hand book, Population council, New York.

Miller S, Tejada A, and Murgueytio P: (2002): Strategic assessment of Reproductive health in the Dominican Republic: Population Council: New York. Pp 14-63.

Mother Care :( 1993): Country projects descriptions, 1989-1993; John Snow Inc., Arlington, USA

Murphy E and Steele C: (1997): Client- provider interaction in family planning services: Guidance from research and program experience. In: Recommendations for updating selected practices in contraceptive use. Vol.- II INTRAH, Chapel Hill.

Murray S.A, Graham L.J: (1995): Practice based health needs assessment: use of four methods in a small neighbourhood: BMJ: 310: 1443-1448.

Murray S.F, Davies S, Phiri R.K, Ahmed Y: (2001): Tools for Monitoring the effectiveness of District Maternity referral System: Health Policy and Planning: 16: (4): 353-361.

Narayan D, Patel R, Schafft K, Rademacher A, Koch-Schulte S: (2000) Voices of the Poor: Can Anyone Hear Us? New York, NY: Oxford University Press for World Bank: p-243.

National Family Health Survey – 2 (NFHS-2): 1998-99, http://www.nfhsindia.org/factsheet.html (accessed on 4th January 2007).

National Sample Survey Organisation (NSSO) report: (1991): http://www.mospi.nic.in/mospi_about_nsso accessed on 4th January 2007.

Orchard C: (1994): Comparing Healthcare Outcomes: British Medical Journals: 308:1493-1496.

Osrin D, Tumbahangphe M K, Mesko DSN, Shrestha P.B. ManandharM.K., Standing H, Manendhar D.S, and Costello A: (2002): Cross sectional ,Community study of Care of Newborn infants in Nepal:9: 325(7372):1063.

Parkhurst J.O, Penn-kekana L, Blaauw D, Balabanova D, Danishevski K, Rahaman S.A, Onama V, Ssengooba F, :2005: Health Systems factors influencing Maternal Health Services; a four- Country Comparison: Health Policy : 73: ( 2) : 127-38.

Pathmanathan I. And Lilfestrand J: (2003): eds: Investing effectively in maternal health in Malaysia and Shri Lanka: The World Bank: Washington DC.

Penn-Kekana L, Parkhurst J and McPake B: (2006): Making progress in reducing maternal mortality and morbidity- need to conceptualise approach to Health System: HSD working paper, HSD/WP/ 15/ 06. Project: http://www.nvbdcp.gov.in/Doc/VBDCP_IPDP.pdf (accessed Feb.10th 2007).

Psacharopoulos G. and H.A.Patrinos: (1994): Indigenous People and Poverty in Latin America; An Empirical analysis, Washington DC: World Bank. Pages – 119-131.

Rama Rao S, Lacvesta M, Costello M, Pangolibay B, Jones H: (2003): The Link between Quality of care and Contraceptive use. Inter.Fam.Plann.Persp: 29:(2) :76-83.

Rawlins B.; Garrison K.; Lynam P. Susan J, Griffey B, Njeru A ; RakuomC.P: (2003): High performing reproductive health care facilities in Kenya - why they exceed expectations: Produced by: US Agency for International Development (USAID): pp 1-35.

Reerink I.H, and Sauerborn R: (1996): Quality of Primary health care in Developing Countries: Recent experiences and Future directions: International Journal for quality and Health care : 8: 131-139.

Registrar General of India (RGI): (1997-98): Sample Registration System Report (SRS): New Delhi: Government of India. RGI, SRS (1997-98) http://www.childinfo.org/cmr/Kh98/KH8AX1IM.pdf

Reproductive and Child Health (RCH) phase –2: 2005: National Program Implementation Plan (PIP): Ministry of Health and Family welfare, Government of India.

Riley A.P: (1994): Determinants of adolescent fertility and its consequences for maternal Health with special references to rural Bangladesh. Ann N. Y. Acad Sci: 18 :( 709): 86-100.

Roemer M I and Montoya- Aguilar C: (1988): Quality assessment and assurance in primary health care: World Health Organisation, Geneva: 105: 1-78.

Romito P, Sauret- Cubizolles M.J, Cuttini M: (1994): Mothers Health after the birth of the first child: The case of employed women in an Italian city: Women Health: 21:2-3: 1-22.

Ronsmans C , Endang A, Gunawan S, Zazri A, McDermott J, Koblinsky M, Marshall T: (2001): Evaluation of a comprehensive home –based midwifery programme in south Kalimantan, Indonesia: Tropical Medicine and international Health : 6: (10): 799-810.

Roooney C: (1992): Antenatal care and Maternal Health: How effective is it? Geneva. World Health Organisation.

Rosenfield A: (1989): Maternal Mortality in Developing Countries: JAMA: 262: (3): 376-379.

Rowe AK, Hamel MJ, Flanders WD, Doutizanga R, Ndoyo J, Deming MS: (2000): Predictors of correct treatment of children with fever seen at outpatient health facilities in the Central African Republic. Am. J .Epidemiol: 151:1029–1035.

Rudoff K, Lawn J, Darmstadt G, Begkoylan G, Fogstad H, Walellgn N, and Paul V: (2005): Systemic Scaling up of Neonatal Care in countries : The Lancet : 365:9464: pp 1087-1098.

Safe Motherhood Initiatives (SMI): (2003): http://www.safemotherhood.org/ accessed on 7/4/2007.

Sauerborn R, Nougtara A, and Diesfeld H.J: (1989): Assessment of MCH services in the district of Solenzo;Bukina Fasco: J.Trop.Pediatrics:35:10-13.

Schellenberg J.A,Victora C.G, Mushi A, De Savigny D, Schellenberg D, et al : (2003): Inequities among the very poor : Healthcare for children in rural southern Tanzania. The Lancet : 361: 561-566.

Schuler S, Bates L, and Islam M: (2002): Paying for reproductive health services in Bangladesh : Intersections between cost ,Quality, and Culture. Health Policy and Planning : 17: (3) : 273-280.

Shea S, et al: (1992) Predisposing factors for severe uncontrolled hypertension. New England Journal of Medicine: 327: 776-781.

Shi L: (1992): The relationship between primary care and life chances. Journal of health care for the poor underserved: 3: 321-335.

Sikosana P.L:(1994):An evaluation of the quantity of ante-natal care at rural health centres in Matebeland north province: Cent.Afr.J.Med: 40(10): 268-272.

Simmons R, and Chris E: (1994): The study of client provider interactions: a review of methodologies issues. Stud. Fam Planning: 25(1): 1-17.

Smith J: et al : ( 2000): The Impact of Traditional Birth Attendant Training on delivery complications in Ghana: Health Policy and Planning : 15: (3): 326-331.

Starfield B: (1992): Primary Care, Concept, evaluation and policy. New York Oxford Press.

Subramanian S.V, Smith G.D, and Subramanyam M: (2006): Indigenous Health and Socio –economic Status in India: PLOS Med: 3: (10): 1794-1804.

Survekshana: ( 1995): round 44th: fifth issue.

Susser M: (1981): Perinatal Nutritional, birth weight and Psychological development: an overview of experiments, quasi-experiments and natural experiments in the past decades: Am.J.Clin.Nutr:34:784-803

Tamar K-K, Campbell O, Shediac-Rizkallah M, Francoise (2000): Women’s experiences of maternity care: Satisfaction or passivity: Social Science and Medicine: 51: 103-113.

Thaddeus S, Maine D: (1994): Too far to walk: Maternal Mortality in Context: Social Science and medicine: 38: 1091-1110.

Thapar R.A: (1990) A history of India. New Delhi: Penguin; P-37-38.

Tomei M. :( 2005): Indigenous and Tribal people: An Ethnic Audit of selected Poverty Reduction Strategy paper: Geneva: International Labour Office: P-3-65.

Trykker H, Simwambana A, Kantu K, Eberhard M: (1994): A primary health care baseline survey in a rural district in Zambia: Afri. J.med. sci.: 23(2): 147-151.

UNFPA and University of Aberdeen: 2004: Maternal Mortality updates 2004; delivery into good hands: UNFPA: New York: Page -9.

UNICEF/WHO/UNFPA: (1997): Guidelines for monitoring the availability and use of obstetric services :UNICEF , New York.

UNICEF: (1999): Plan of Action district cluster strategy, UNICEF India. Bihar Field Office, Patna.

UNICEF: (2004): State of the world’s Children 2005: New York: UNICEF.

United Nation Children’s Fund (UNICEF): (2006): The Millennium Development Goals: Progress and Challenge in South Asia: United Nations Children’s Fund (UNICEF) Regional Office for South Asia: pp 14-15.

United Nations (UN) :( 2004): The concept of indigenous people: New York: United Nations.

United Nations Children’s Fund (UNICEF): (1999): Trends in Childhood Mortality in the developed World 1960-1996. New York: UNICEF.

United Nations Fund for Population Activities (UNFPA): (2000): The state of the worlds Population 2000: Lives together worlds apart: New York: UNFPA.

UNPFII :(2006): UN Economic and Social council, permanent Forum on Indigenous Issue, fifth session, Action programme for second Indigenous Decade Launch . P- 1-38.

Walker S.P: (1997): Nutritional issues for women in developing Countries: Proc. Nutr. Soc: 56: (1b) 345-56.

Wardlaw T. and Maine D: (1999): Process Indicators for maternal mortality programs in safe motherhood initiatives: critical issues: M.Berer and T.S. Ravindran, Editors, Reproductive Health Matters.

WHO (1991): Patient flow analysis, An overview of national and international application: World Health Organization, Geneva.

WHO (1995): Progress report of maternal health and safe motherhood program 1993-1995: World Health Organization, Geneva.

WHO and United Nations Children’s Fund (UNICEF) :( 1996): Revised 1990 estimate of maternal Mortality. A new approach by WHO and UNICEF: Geneva: World Health Organisation,

World Health Organisation (WHO) : (1996) : Essential New Born Care. Report of a Technical Work group ( Trieste ,25-29 April 1994): Geneva , WHO, Division of Reproductive Health (Technical Support) .

World Health Organisation (WHO) :1989: The prevention and management of post-partum haemorrhage : report of technical working group : Geneva 3-6 july 1989: Geneva.

World Health Organisation (WHO): (1994): Mother baby package: implementing safe motherhood in countries; World Health Organization, Geneva: 15: 4-7.

World Health Organisation (WHO): (1994b): Indicators to monitor maternal health goals : Report of a Technical working group ,Geneva ,8-12 Nov. 1993: Geneva .

World Health Organisation (WHO): (1998): Child Health and Development 1996–97 Report. Geneva, Switzerland: World Health Organization.

World Health Organisation (WHO): (2001): The UN children’s Fund, The UN Population Fund. Maternal Mortality in 1995: Estimates developed by WHO, UNICEF, UNFPA. Document WHO/RHR/01.9 Geneva: World Health Organisation.

World Health Organisation (WHO): 2006: Maternal Mortality fact Sheet 2006:World Health statistics-2006: http://www.who.int/whosis/mort/profiles/en/index.html

World Health Organisation (WHO):( 2002): World Health Report : Geneva : World Health Organisation.

Zeitz P.S, Salami C.G, Brunham G, Goings S.A, Tijani K, and Morrow R.H, ( 1993): Quality assurance management methods applied to a local –level primary health care system in rural Nigeria: International J. of health planning and management : 8: 235-244.