Spreading Information About Entitled Services Enhances Delivery Of Health And Social Services In Rural India

Main Category: Public Health
Article Date: 29 Oct 2007 - 1:00 PDT


Providing a structured informational program about entitled health and social services to resource-poor rural villagers in India improved the delivery of these services to the people who may need them, according to a study in the October 24/31 issue of JAMA, a theme issue on poverty and human development.

This issue of JAMA is being released early because of JAMA's participation in an international collaboration of more than 200 medical and scientific journals to publish articles simultaneously to raise awareness on the topic of the relationship between poverty and human development. This initiative is coordinated by the Council of Science Editors, and presentations regarding some of the studies in this Global Theme Issue will be webcast live from the National Institutes of Health (Click here).

The delivery of health and social services in developing countries such as India is often inadequate - in part, because of limited resources allocated by governments and donor agencies. However, increased spending alone may not be sufficient to improve outcomes. Lack of awareness about entitled health and social services may contribute to poor delivery of those services in developing countries, especially among people of low socioeconomic status, according to background information in the article.

Priyanka Pandey, Ph.D., of South Asia Human Development, the World Bank, Washington, D.C., and colleagues conducted a community-based, cluster randomized controlled trial to determine the effect of informing resource-poor rural populations about entitled services. The study was conducted from May 2004 to May 2005 in 105 randomly selected village clusters in Uttar Pradesh state in India. (Uttar Pradesh ranks 23 out of 32 states in India in terms of the proportion of people living below the poverty line.) There were 536 households included in the intervention and 489 control households. Four to six public meetings were held in each intervention village cluster to disseminate information on entitled health and education services. No intervention took place in control village clusters.

"After one year, intervention villagers reported better delivery of several services compared with control villagers," the authors write.

"Improvements occurred in pre-natal services, infant vaccinations, excess school fees, and occurrence of village council meetings," they continue. "Although nurse midwife visits did not increase, 20 percent to 25 percent more households in intervention villages reported that women were receiving pre-natal services and that their infants were being immunized, suggesting that the nurse midwife was performing more duties when a visit did occur." Almost all outcomes improved in intervention villages, while most outcomes either worsened or remained unchanged in control villages.

"Seventy percent of India's population lives in the villages and would benefit from improved basic services. Interventions that educate resource-poor populations about entitled services may improve the delivery of services," the authors conclude. "Such interventions are promising and low-cost means to improve the health and welfare of individuals in developing countries."

JAMA. 2007;298(16):1867-1875

More information about the Council of Science Editors' Global Theme Issue on Poverty and Human Development is available here.

More information about the NIH Global Theme Issue event, 10 a.m. (ET) Monday, October 22, 2007, is available here.

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