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eliable and regular immunisation, maternal and child care facilities and, above all, nutritional
support and pre-school education through the ICDS programme can make the initial difference in
accessing primary schooling. Despite no dramatic difference in the social and economic status of
the poorest strata in all the three states, the difference on the ground is palpable. Relatively better
functioning of healthcare, immunisation, child nutrition and primary schooling programmes in the
two southern states has made a big difference. The obverse however holds true for Uttar Pradesh.
Variations between Uttar Pradesh on the one hand and Karnataka and Andhra Pradesh on the
other on the functionality of health care services are stark. Notwithstanding differences,
consumption of IFA tablets was low in all the three states. There are several reasons for this,
namely: lack of understanding among women of the importance of IFA, the focus on distribution
rather than on enabling consumption (explaining side effects, timing of consumption, the need to
eat before consuming, and creating an association to ensure regular consumption). Equally, the
current form in which IFA is given needs revision. Field observations suggest that IFA in the
form of a tonic maybe better accepted than as a tablet, as there is a close perceived association
between a tablet and ill health. The composition also needs to be examined at a technical level.
Current IFA is Ferrous sulphate with unpleasant side effects; passably Ferrous Fumarate
formulations may be better. Tetanus immunisation of pregnant women is also very low. However,
with increase in immunisation services provided in childhood and also targeting the adolescent
girls for tetanus immunisation, this problem can be overcome in the future.
The ANMs, where regular, tend to focus on the following in order of priority – immunisation,
family welfare, care of pregnant women and distribution of ORT etc. However, the felt demand
and need of the poor seems to be for curative services, which is mostly met by the village
practitioners or private sector. AP is the exception, where 66% of households surveyed utilised
the government facilities (see Table 27). This higher percentage usage may be because of the
recent commencement of urban health posts in urban slums in AP. However, the village
practitioners and the private sector in neither state deliver family welfare services and their
participation in immunisation and care of pregnant women is very limited – a glaring lacunae.
The high reliance of the poor on village practitioners for curative services could be utilised for
immunisation and care of pregnant women after appropriate training and with the ANM playing a
pivotal role in forging the linkages.
Educational Resource Unit Page 83 April 2003