Ministry of Health and Family Welfare Government of India. Concurrent Evaluation of National Rural Health Mission. Karnataka

Transcription

1 Ministry of Health and Family Welfare Government of India Concurrent Evaluation of National Rural Health Mission 2009 Karnataka INTERTIOL INSTITUTE FOR POPULATION SCIENCES (Deemed University) MUMBAI - 88

2 INTERTIOL INSTITUTE FOR POPULATION SCIENCES Vision: "To position IIPS as a premier teaching and research institution in population sciences responsive to emerging national and global needs based on values of inclusion, sensitivity and rights protection." Mission: "The institute will strive to be a centre of excellence on population, health and development issues through high quality education, teaching and research. This will be achieved by (a) creating competent professionals, (b) generation and dissemination scientific knowledge and evidence, (c) collaboration and exchange of knowledge, and (d) advocacy and awareness."

3 Ministry of Health and Family Welfare Government of India Concurrent Evaluation of National Rural Health Mission 2009 Karnataka INTERTIOL INSTITUTE FOR POPULATION SCIENCES (Deemed University) MUMBAI 88 JUNE, 2011

4 Suggested citation: International Institute for Population Sciences (IIPS), Concurrent Evaluation of National Rural Health Mission (NRHM), Karnataka, 2009: Mumbai: IIPS. For additional information. please feel free to contact: Director/Project Coordinator (CE-NRHM) International Institute for Population Sciences Govandi Station Road, Deonar Mumbai (India) Telephone: /5, , Fax: , ce_nrhm@iips.net Website: Additional Director General (Stat.) Ministry of Health and Family Welfare Government of India Nirman Bhawan, New Delhi Telephone: Fax: adg-mohfw@nic.in Chief Director (Stat.) Ministry of Health and Family Welfare Government of India Nirman Bhawan, New Delhi Telephone: Fax: cdstat@nic.in Website:

5 CONTRIBUTORS Manoj Alagarajan Johnson Thangaraj Diana Picardo

6 IMPORTANT INSTRUCTIONS TO READERS This report is based on a sample of selected districts from Karnataka. A combined figure for Karnataka is simply the unweighted average of the information obtained from selected districts. As such, the combined figures may not be representative of the state but provide situation of selected districts only. Readers are advised to take note if comparing with other survey results for the state of Karnataka. It is also very important to keep in mind that the information collected to compute various indicators refer to different time periods. For examples, information related to any birth occurred after January 1, 2006 was collected. However, the information on place of delivery, delivery assisted by health personnel, and JSY beneficiaries were collected only for the last birth that occurred after January1, The indicators presented in the report are expressed in terms of numbers, averages or percentages. The details of the selection of districts, sampling of health facilities and households are available in this reports. The survey instruments used to collect information are also enclosed in a CD along with this report.

7 CONTENTS List of Tables Abbreviations Acknowledgement Executive Summary Page ix xiv xvi xviii CHAPTER 1: INTRODUCTION 1.1 Objectives of NRHM Concurrent Evaluation of NRHM Survey design and methodology Survey instruments Recruitment, training and fieldwork Data processing, validation and quality assurance Chapter scheme. 7 CHAPTER 2: HOUSEHOLD RESPONSE TO NRHM: KNOWLEDGE, PRACTICE AND HEALTH SEEKING BEHAVIOUR 2.1 Household characteristics Water, sanitation and waste disposal Awareness of NRHM activities Health seeking behavior 10 CHAPTER 3: WOMEN'S RESPONSE TO NRHM 3.1 Profile of the eligible women Utilization of maternal and child health services Birth weight of the child Place of delivery Antenatal, natal and postnatal care received by the women for the most recent birth Immunization among Children Breastfeeding practices Awareness of women about hygiene and health related matters Awareness of family planning Knowledge about HIV/AIDS Awareness of ICTC and PPTCT centers Awareness of ASHA and services received Awareness of women about VHSCs Awareness of women about VHNDs Awareness of women About NPT kit v

8 CHAPTER 4: JANI SURAKSHA YOJA (JSY) 4.1 Woman's awareness and source of awareness of the JSY scheme Caste profile of the JSY beneficiaries Motivator for registering under JSY scheme Place of registration Health workers registered under JSY scheme Timing of registration under JSY scheme Availability of JSY Card Problems faced in the registration Advice received from the ASHA/ANM/HW during Pregnancy/Antenatal Period Place of delivery Profile of the institutional deliveries under JSY Motivation for institutional delivery Types of help received by the beneficiaries for institutional delivery Mode of payment for JSY money Timing of receipt of JSY money Difficulty faced in getting the Incentive money Purpose for which incentive money used.. 69 CHAPTER 5: COMMUNITISATION OF SERVICES 5.1: Rogi Kalyan Samiti (RKS) Rogi Kalyan Samities in the CHCs has been registered and notified Fund generation and utilisation by Rogi Kalyan Samiti in CHCs and PHCs Awareness and utilisation of untied fund at Health Sub- Centre Knowledge on Rogi Kalyan Samiti by households : Role of Accredited Social Health Activist (ASHA) Profile of ASHA Training undergone by ASHA ASHA's Awareness about breastfeeding, Diarrhoea, Acute Respiratory Infections, and Major Features of NRHM Medical Items/Kits Available with ASHA and whether those Items/Kits were Used by ASHA Activities performed by ASHA Incentives received, difficulties faced, and support required to effectively Implement NRHM. 99 vi

9 5.3: Gram Panchayat (GP) Profile of Gram Panchayats and Distance from the Health Facility Establishment of Village Health and Sanitation Committee and Preparation of Village Health Plan Problems faced by Village Health and Sanitation Committees and Diseases Prevalent in the Villages Problems and support required in implementation of NRHM 114 CHAPTER 6: HEALTH SUB- CENTRES (HSCs) AND FUNCTIONING OF ANMs A. State of the health-sub centres 6.1 Characteristics of the Health Sub-Centres Infrastructure and amenities Ante Natal Care (ANC) services and immunization Delivery and other related facilities Registers availability and modes of maintenance B. Characteristics and skill-building of ANMS 6.6 Background Characteristics of the ANMs. 126 C. Performance of ANMS at the facility and in the community 6.7 Untied Funds and Implementation of Programmes Awareness about Important Activities under NRHM Ante Natal Care (ANC) and Post Natal Care Services, including Immunization ANC Services Deliveries and Immunizations/Supplements Administered Women's health: high-risk pregnancies, Diseases/Illness managed ANMs' interaction with other health functionaries CHAPTER 7: PHYSICAL INFRASTRUCTURE AND HUMAN RESOURCES CHAPTER 7.1: DISTRICT HOSPITAL Physical infrastructure at surveyed District Hospitals Human resources in surveyed District Hospitals Training of human resources in surveyed District Hospitals Average monthly service outcome at surveyed District Hospitals Maintenance of records and Health Management Information System in surveyed District Hospitals vii

10 CHAPTER 7.2: COMMUNITY HEALTH CENTRE Population served and accessibility to the Community Health Centres by public transport Physical infrastructure at surveyed Community Health Centres Human resources in surveyed Community Health Centres Human resources training in Community Health Centres Service outcome at Community Health Centres Maintenance of hospital records and Health Management Information System at Community Health Centres CHAPTER 7.3: PRIMARY HEALTH CENTRE Population served and accessibility to the Primary Health Centres by public transport Physical infrastructure at surveyed Primary Health Centres Human resources in surveyed Primary Health Centres Human resources training in Primary Health Centres Service outcome at Primary Health Centres Maintenance of hospital records and Health Management Information System at Primary Health Centres. 167 CHAPTER 8: CLIENTS' RESPONSE TO NRHM 8.1 Response of In-Patients Response of Out-patients Appendix A Nodal Agency staff involved in Concurrent Evaluation of NRHM 191 Appendix B Technical advisory committee for Concurrent Evaluation of NRHM viii

11 LIST OF TABLES AND FIGURES Table 2.1 Percent distribution of households by selected characteristics.. 13 Table 2.2 Percent distribution of households by household amenities and assets.. 14 Table 2.3 Percent distribution of households according to household sanitation practices and waste disposal.. 16 Table 2.4 Percent distribution of household respondent according to their knowledge about health personnel 17 Table 2.5 Percentage of households aware about various NRHM activities.. 18 Table 2.6 Percentage of households reported being aware about ASHA by background characteristics. 19 Table 2.7 Percentage of households reported being aware about JSY by background characteristics. 20 Table 2.8 Percentage of households according to knowledge of selected diseases 21 Table 2.9 Percentage of households according to use of different type of medicines 22 Table 2.10 Percentage of households by facilitated in blindness control program.. 24 Table 2.11 Percentage of households using mosquito net and practices for malaria prevention for pregnant woman.. 25 Table 2.12 Percentage of households reporting any member suffered or currently suffering from tuberculosis and treatment taken 27 Table 2.13 Percent distribution of households reported any member suffered or currently suffering from leprosy and treatment taken 28 Table 3.1 Profile of the surveyed eligible by selected background characteristics 43 Table 3.2 Percent distribution of currently married women aged who had births during the reference period (January, 2006 to survey date) by number of live births, survival status and sex ratio of the children born 44 Table 3.3 Children born during the reference period (January, 2006 to survey date) and were alive at the time of survey by whether their birth weight was taken, timing of birth weight and reason for not taking birth weight among those who were not weighed. 45 Table 3.4 Place of delivery and type of assistance for home deliveries for all births during the reference period 46 Table 3.5 Percentage of currently married women aged who had received at least one TT injection during pregnancy, advice on post natal care, family planning, place of delivery and type of assistance at the time of delivery in case of home delivery for the most recent birth Table 3.6 Immunization status of the all children born during the reference period and reason for non-immunization or partial immunization Table 3.7 Percentage of children aged months among children born during last three years preceding the survey by immunization status.. 49 Table 3.8 Among the youngest surviving child born during the reference period, percentage ever breastfed, percent distribution by timing of initiation of breastfeeding, and by duration of exclusive breastfeeding. 50 Table 3.9 Percentage of currently married women aged years by awareness about hygiene and health related matters. 51 Table 3.10 Percent distribution of currently married women aged by knowledge of methods of family planning 52 ix

12 Table 3.11 Table 3.12 Table 3.13 Table 3.14 Table 3.15 Table 3.16 Concurrent Evaluation of NRHM Percent distribution of currently married women aged years by knowledge about various aspects of HIV/AIDS. 53 Percentage of currently married women aged years who have heard of HIV/AIDS by knowledge about ICTC, PPTCT centres and whether they have undergone HIV Test Percentage of currently married women aged years by knowledge about ASHA. 55 Percentage of currently married women aged years by knowledge about Village Health Sanitation Committee (VHSC).. 56 Percentage of currently married women aged years by knowledge about Village Health and Nutrition Days (VHND). 57 Percentage of currently married women aged years by knowledge about Nischay Pregnancy Test (NPT) kit. 58 Table 4.1 Percent distribution of currently married women aged who are aware of Janani Suraksha Yojana (JSY) scheme and source of information on JSY Table 4.2 Out of those women who had given at least one live birth since January 2006, percentage of women who are JSY beneficiaries by social category. 71 Table 4.3 Percentage of JSY beneficiaries by motivator for registering under JSY, place of registration and health worker who registered Table 4.4 Percentage distribution of the JSY beneficiaries by timing of registration and availability of JSY card.. 73 Table 4.5 Percentage of JSY beneficiaries who received advice from ANM/ASHA/Health Worker during pregnancy/ante natal period and place of delivery 74 Table 4.5a Percentage of JSY beneficiaries delivering at home by reasons for preferring for home delivery. 75 Table 4.6 Profile of the Institutional deliveries under JSY scheme Table 4.6a Difficulties faced in reaching the health facility for Institutional deliveries for the JSY beneficiaries.. 77 Table 4.7 Percentage of women who delivered in Institution/facility by problems faced in reaching the facility and the person who motivated them to go for institution for delivery.. 78 Table 4.8 Percentage of JSY beneficiaries who delivered in a health institution/facility by type of help received from the ASHA/ANM/VHSC and others 79 Table 4.9 Percentage of JSY beneficiaries by type of payment for incentive money, timing of receipt of incentive money, person who gave her the incentive money, difficulties faced in getting the incentive money 80 Table 4.10 Percentage of JSY beneficiaries by purpose for which incentive money was used. 81 Table Availability and functioning of Rogi Kalyan Samiti (RKS) among surveyed CHCs Table Source of availability and utility of funds generated by Rogi Kalyan Samiti (RKS) at surveyed CHC. 86 Table Source of funds generated by Rogi Kalyan Samiti (RKS) at surveyed PHC. 87 Table Number of ANMs reporting utilisation of untied fund and related issues under NRHM in the surveyed Health Sub-Centres.. 88 Table Grants received and spent by the surveyed Health Sub-Centres 89 Table Percentage distribution of households having knowledge of Rogi Kalyan Samiti (RKS) 90 x

13 Table Percent distribution of ASHA by selected background characteristics Table Percent distribution of ASHA by type of house and percentage of ASHA residing in households having basic amenities and using mosquito nets Table Percent distribution of ASHA by population served, distance travelled and time taken to reach the farthest village, and percentage of ASHA reporting about the person/authority that nominated/recommended/appointed her as ASHA Table Percentage of ASHA who had undergone ASHA training, topics covered in the training, duration, place and usefulness of last training, and undergone training on use of Nishchay Pregnancy Test kit (NPT) kit. 104 Table Percent distribution of ASHA by awareness about initiation of breastfeeding and exclusive breast feeding, and percentage of ASHA who were aware about important steps for prevention of diarrhoea, symptoms of pneumonia/aris, and major features of NRHM 105 Table Percentage of ASHA who received items and kits, and percentage of ASHA reporting availability of other items and medicines with them at the time of survey Table Percentage of ASHA reporting the source from where they received NPT kit and follow-up measure taken after use of NPT kit, and percent distribution of ASHA by number of NPT kits used and whether women are usually able to interpret NPT results Table Percentage of ASHA by the activities performed and percentage of ASHA by help that she provides to improve sanitation in her communities Table Percent distribution of ASHA by her performance against selected activities under JSY and family planning during October to December Table Percent distribution of ASHA by her performance against selected activities under vector born disease control programme and number of meetings, including village health and nutrition day 110 Table Incentives received by ASHA under various programmes under NRHM Table Percentage of ASHA reporting various difficulties faced in implementing NRHM and support that they require to effectively implement various programmes under NRHM. 112 Table Profile of the Gram Panchayat Table Distance from Gram Panchayat village to nearest health facilities 117 Table Number of Gram Panchayats reported Village Health and Sanitation Committee (VHSC) and preparing village plan 118 Table Number of Gram Panchayat facing major problems and common diseases as reported by Village Health and Sanitation Committee and Gram Panchayat functionaries Table Number of Gram Panchayat facing problem in implementing of NRHM and Support Required 120 Table Number of Gram Panchayat Acknowledging NRHM for Improvement in Health Facility Table 6.1 Number of Health Sub-Centres by selected characteristics, population covered, accessibility, transport available and other health facilities nearby Health Sub- Centres Table 6.2 Number of Health Sub-Centres with selected physical characteristics and facilities, overall human resources and cleanliness of the buildings xi

14 Table 6.3 Number of Health Sub-Centres by selected environmental risk, sanitation and health related amenities, including waste management Table 6.4 Number of Health Sub-Centres with selected communication amenities, including mode of payment of bills and having stand-by generators. 135 Table 6.5 Number of Health Sub-Centres performing selected ANC services performed in nine months prior to the survey Table 6.6 Number of Health Sub-Centres equipped with delivery facilities, including cold chain Table 6.7 Number of Health Sub-Centres by type of records/registers maintained and availability at the time of survey Table 6.8 Number of ANMs by selected characteristics 139 Table 6.9 Number of ANMs trained on selected family planning methods, ante-natal services, RTI/STIs and immunizations Table 6.10 Number of ANMs aware about NRHM, implementation and reporting the impact on their status as ANM Table 6.11 Ante Natal Care (ANC), Deliveries and Post Natal Care (PNC) services performed by ANM 143 Table 6.12 Average number of women with illnesses, delivery and complicated cases managed by ANMs. 144 Table 6.13 Number of ANMs/HSCs by activities related to ICDS and ASHA Table Number of surveyed district hospitals with physical infrastructure Table Number of human resources in surveyed district hospital Table Number of surveyed district hospital having human resources trained by type of training Table Average monthly service outcomes at surveyed district hospital Table Number of surveyed district hospitals by maintenance of records and health management information system (HMIS) Table Average population served and accessibility to the surveyed CHCs by public transport Table Number of surveyed CHCs with physical infrastructure 160 Table Number of surveyed CHCs with human resources. 161 Table Number of surveyed CHCs having human resources trained by type of training 162 Table Average service outcomes per CHC Table Number of surveyed CHCs by record maintenance/pre-printed cards Table Average population served and accessibility to the surveyed PHC by public transport Table Number and percentage of surveyed PHCs with physical infrastructure Table Number of surveyed PHCs with human resources. 171 Table Number of surveyed PHCs having human resources trained by type of training Table Average monthly service outcomes per PHC from 1st April -31st December Table Number and percentage of surveyed PHCs with record maintenance/pre-printed cards 174 Table 8.1 Background characteristics of in-patients 177 Table 8.2 Percentage of in-patients with ailment for which admission is sought in Health Institutions Table 8.3 Percentage of in-patients using different modes of transport to reach Health Institutions xii

15 Table 8.4 Percentage of in-patients by duration of stay in Health Institutions Table 8.5 Percentage of In-Patients reporting about behaviour of doctor and paramedical staff. 181 Table 8.6 Percentage of in-patients reporting cleanliness of health facilities 182 Table 8.7 Percentage of in-patients reporting satisfaction with treatment & reasons for not satisfaction in Health Institutions Table 8.8 Percentage of in-patients reporting services available in Health Institutions. 184 Table 8.9 Background characteristics of the out-patients Table 8.10 Percentage of out-patients with ailment for which you visited Health Institutions Table 8.11 Percentage of out-patients using different modes of transport to reach Health Institutions Table 8.12 Number of visits made for current illness Table 8.13 Percentage of out-patients reporting about the behaviour of doctor and paramedical staff 189 Table 8.14 Percentage of out-patients reported satisfaction with treatment 190 Figure 1.1 Sampling Frame of Concurrent Evaluation of NRHM... 3 xiii

16 ABBREVIATIONS ANC ANM AIDS APL ARI ASHA AWC AWW AYUSH BCG BEE BP BPL CHC CSPro DBCS DH DOTS DPT EAG ECG ECP EMOC FRU FP GDMO GDP GP HH HPS HIV HMIS HSC ICU IEC IFA ICTC IMNCI Antenatal Care Auxiliary Nurse Midwife Acquired Immunodeficiency Syndrome Above Poverty Line Acute Respiratory Infection Accredited Social Health Activist Anganwadi Centre Anganwadi Worker Ayurveda, Yoga, Unani, Siddha and Homeopathy Bacillus Calmette-Guerin Block Extension Educator Blood Pressure Below Poverty Line Community Health Centre Census and Survey Processing System District Blindness Control Society District Hospital Directly Observed Treatment Short-Course Diphtheria Pertussis Tetanus Empowered Action Group Electro Cardiogram Emergency Contraceptive Pill Emergency Obstetric Care First Referral Unit Family Planning General Duty Medical Officer Gross Domestic Product Gram Panchayat Households High Performing State Human Immunodeficiency Virus Health Management Information System Health Sub-Centre Intensive Care Unit Information, Education and Communication Iron and Folic Acid Integrated Counseling and Testing Centre Integrated Management of Neonatal and Child Infections xiv

17 ABBREVIATIONS IPD IPHS IUD JSY LHV LPG LPS MCH MDT MHW MPW MO MTP NBCC NGO NPT kit NRHM NSV OBC OPD OPV ORS OT PHC PNC PPH PPTCT PRI RH RKS RMP RTI SC SDH SBA SHG ST STI TAC TB TFR TT UNFPA UNICEF UT VHND VHSC VIP WHO In-Patient Department Indian Public Health Standard Intra Uterine Device Janani Suraksha Yojana Lady Health Visitor Liquefied Petroleum Gas Low Performing State Maternal and Child Health Multi-Drug Therapy Male Health Worker Multi Purpose Worker Medical Officer Medical Termination of Pregnancy New Born Care Corner Non-Government Organization Nishchay Pregnancy Test kit National Rural Health Mission Non Scalpel Vasectomy Other Backward Classes Out-Patient Department Oral Polio Vaccine Oral Re-hydration Salt Operation Theatre Primary Health Centre Post Natal Care Post Partum Hemorrhage Prevention of Parent to Child Transmission Panchayati Raj Institution Rural Hospital Rogi Kalyan Samiti Registered Medical Practitioner Reproductive Tract Infection Scheduled Caste Sub Divisional Hospital Skill Birth Attendance Self Help Group Scheduled Tribe Sexually Transmitted Infection Technical Advisory Committee Tuberculosis Total Fertility Rate Tetanus Toxoid United Nations Population Fund United Nations Children s Fund Union Territory Village Health and Nutrition Days Village Health and Sanitation Committee Ventilation Improved Pit World Health Organization xv

18 Acknowledgement The Concurrent Evaluation of National Rural Health Mission, conducted during May to August 2009, was a nationwide survey funded by the Union Ministry of Health and Family Welfare. This report is based on the completed work in 7 districts of Karnataka. We are very grateful to the Ministry of Health & Family Welfare, Government of India for designating the International Institute for Population Sciences (IIPS) as the Nodal agency for the Concurrent Evaluation of NRHM Project and providing an opportunity to work closely with the health and programme officials. In particular, we are thankful to Mr. K. Chandramouli, Secretary, Ministry of Health and Family Welfare, Govt. of India for his support and encouragement. We would also like to thank Mr. Naresh Dayal, Ms. K. Sujatha Rao, former Secretaries -Ministry of Health and Family Welfare, Government of India and Mr. P. K. Pradhan, Special Secretary & Mission Director (NRHM) for their suggestions and support. Our special thanks to Smt. Madhu Bala, the Additional Director General, Dr. Rattan Chand, the Chief Director, Mr. Pravin Srivastava, Deputy Director General, Mr. Rajesh Bhatia, Director, Mr. Biswajit Das, Director, Dr. S.C. Agrawal, Assistant Director and Mr. S. K. Kapoor, Investigator -Statistics Division, Ministry of Health and Family Welfare, Government of India for their active involvement and suggestions. We are grateful to Mr. S.K Das, Dr. V.K. Malholtra, former Additional Director Generals, Ms. Rashmi Verma, former Deputy Director- Statistics Division, Ministry of Health and Family Welfare, Govt. of India for their co-operation and support at the initial stage of this work. We acknowledge the contribution of the Field Agency for their involvement in data collection in the project. Our thanks are due to the members of Technical Advisory Committee (TAC) of Concurrent Evaluation NRHM and especially to its Chairman, Dr. P. M. Kulkarni, Professor, Jawaharlal Nehru University, New Delhi. We gratefully acknowledge the immense contributions of Concurrent Evaluation NRHM project team at IIPS in developing survey instruments, training of field staff, monitoring field work, data processing, preparation of state level fact sheets, and drafting the state level report. Finally, our heartfelt thanks to state and district level health officials and respondents for extending their co-operation by providing us valuable information without which the project would not have been successfully completed. Co-odirnators/Contributors Concurrent Evaluation of NRHM xvi

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20 EXECUTIVE SUMMARY The objective of the Concurrent Evaluation of NRHM is to assess the reach of NRHM activities to the rural communities. The concurrent evaluation was carried out in the state of Karnataka. In this report, we provide key findings on the household and women s response to NRHM including Janani Suraksha Yojana (JSY), and outcomes of the core strategies of NRHM like communitisation of services and innovations at community level. It also presents functioning of ANMs, ASHA and the status of physical infrastructure and human resources at the health facility levels. Household response A total of 8,319 households were covered in the state of Karnataka. A little lower than half of the respondent households were other backward classes (OBCs), 26 percent belonged to scheduled castes and 10 percent belonged to scheduled tribes. About 44 percent of the respondents had no education. About 54 percent of respondents reported knowing only about ANMs and 39 percent knowing about both ANMs and Male health worker. A little above 3/4th of the respondents were aware about JSY. On the other hand awareness on both RKS and VHSC was very low and reported by only 3 and 18 percent of the respondents respectively. At household level allopathic system of medicine was generally used (99 percent). Only 3 percent and less of the households reported use of homeopathy, siddha and ayurvedic system of medicine. About 71 percent of the households reported availing services from private clinics when needed followed by PHCs (48 percent), CHCs (30 percent), DH/sub-divisional hospitals (23 percent), and HSCs (12 percent). About 74 percent reported going to private clinics followed by 39 percent to district hospital, 34 percent to PHC, 28 percent each to subdivisional hospital and CHC for treating serious ailments. At household level, the awareness on Malaria was reasonably high with 68 percent of respondents reported to have knowledge about Malaria, followed by Dengu (17 percent), Kala-Azar (3 percent), Filariasis (1 percent) and Japanese Encephalitis (less than percent). About onef-fifth of the households reported that any member of their households had high fever lasting for more than one month. However, almost all of them had got treated for the high fever and the preferred place for treatment was private clinics (70 percent), followed by PHCs (41 percent), CHCs/RHs (29 percent), and DH/Sub-divisional hospitals (25-26 percent). About half of the households reported that none of their members had used xviii