Role of community based health care programs in mitigating association of social class and demographic and health inequity: Evidence from a rural community of North India

Yadav, Kapil

INTRODUCTION:

Community based health care programs by ensuring universal health coverage can address inequity in health. Present study was undertaken to compare select demographic and health indicators across different social classes in a rural community of North India which has received intensive community based health care over last six decades.

METHODS:

Present study is a secondary data analysis (2009-12) from Health and Management Information System (HMIS) of Ballabgarh Health and Demographic Surveillance System site, Comprehensive Rural Health Service Project (CRHSP), Ballabgarh. Select demographic and health indicators were compared across different strata of social classes [Upper class and middle (UMC) Vs Lower class (LC)]. The social classes were categorized on the basis of the list issued by the state government of Haryana. CRHSP, Ballabgarh is one of the flagship program of AIIMS in existence since 1965 with focus on community based health care.

RESULTS:

The total population of the study area was 92,070 (31^st December 2012) with 25.4% belonging to LC. Crude birth rate and death rate in the UMC population was 20.9 and 6.3 while in LC it was 21.4 and 6.5 respectively. The sex ratio of the upper class (879 females per 1000 males) was low in comparison to the sex ratio of the lower class (911 females per 1000 males). The neonatal mortality rate was 26/1000 live births in UMC while it was 26.8/1000 live births in LC. Institutional deliveries and immunization status were similar in both the groups. The induced abortion rate in the LC was 4.8/1000 live births while in UMC it was 3.1/1000 live births (p=0.64). Incidence of LBW was 18.8/1000 live births in LC while in UMC it was 16.7/1000 live births (p=0.21).

CONCLUSIONS:

As per NFHS 3, most of the above mentioned indicators were skewed towards the lower class of population. The demographic and health differentials are narrower in Ballabgarh HDSS as compared to rest of Haryana and India. Intensive community based health care delivery program by CRHSP AIIMS team could be possible factor for this observation.