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Scope of health systems research in Child Survival and Safe Motherhood programme.


 Editorial commentary focused on several Health System Research (HSR) approaches which exemplified some of the key issues for application of HSR for further improvement in Maternal and Child Health (MCH) services in India. The goals of HSR are to delineate health policy which improves the operations of the health care delivery system for sustainability at the district level. HSR is part of a global effort of Health For All by 2000 AD and India's Child Survival and Safe Motherhood (CSSM) program, sponsored by IDA/UNICEF. CSSM aims also to end polio by 2000 AD, eliminate neonatal tetanus by 1995, and prevent deaths and morbidity from measles, diarrheal diseases, and acute respiratory infection. MCH services will be expanded at the village, subcenter, primary health center, and community health center levels in order to reduce maternal mortality to below 2/1000 from the 1990 5/1000 and to reduce mortality of children aged 1-4 years to less than 10/1000 live births from 80/1000 by 2000 AD. States with particularly high levels of child and maternal mortality are Bihar, Uttar Pradesh, Rajasthan, and Madhya Pradesh, which have about 40% of India's population. These states have low marriage ages, low female literacy, and few women in nonagricultural employment. There are about 90 districts in these states with particularly low demographic indicators. India policy directs all CSSM work to be carried out by existing staff; the program emphasis will be training, supervision, and logistics. IEC will need to be directed to attitudinal change in rural areas and urban slums. Research has found that coverage is uneven and quality of MCH services, poor. One study will evaluate the performance over 5 years in Gwalior district in a nutrition and school health program. Another research effort will perform quality assessment of MCH care at the primary health care level and promote community awareness and increased utilization. An ongoing study is evaluating nationally the family welfare services and MCH program at the primary health center level. The several agencies conducting HSR included the National Institute of Health and Family Welfare, the Indian Council of Medical Research, and the BJ Medical College. Multidisciplinary research is still needed in order to understand the malnutrition among pregnant mothers and use of health services by women.
