[SHSTF's union lawyer on current regulations for parents' allowance for sick children: no increased responsibility for district health nurses and child health center nurses].
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State outcomes monitoring systems are increasingly important as state governments develop outcomes-based accountability in response to recent federal legislation. A state outcomes monitoring system developed for state and local maternal and child public health departments allows for outcomes research as well as administration and management.
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The performance of a sample of 112 refresher trained Maternal and Child Health Workers (MCHW) was assessed over a nine-month period, using a self-reporting questionnaire. The findings show that the MCHWs are providing obstetric services, including antenatal care, birth attendance and postnatal and newborn care, at community level and identifying complications for referral, but their productivity levels are very low, particularly in the remote hill areas, where they are most needed. In order to increase their effectiveness, greater emphasis needs to be placed on the creation of an enabling environment, both in terms of professional support and recognition at community level. This requires more technical and logistical backup and the promotion of greater awareness amongst women and their families about the importance of midwifery care and skilled birth attendance.
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Child care can be improved by using a child health summary card, writes Sheila Jeffries. This would highlight the common needs of all children and their families, the special needs of certain types of families and the evaluation of methods employed. Additionally this scheme would provide data to help define the purpose of the work of the health visitor and school nurse.
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Child health is a central issue in the public policy agenda of developing countries. Several policies aimed at improving child health have been implemented over the years, with varying degrees of success. In Brazil, such policies have triggered a significant decline in infant mortality rates over the last 30 years. Despite this improvement, however, mortality rates are still high compared to international standards. Moreover, there is considerable imbalance across Brazilian municipalities suggesting that various policies should be adopted. We investigate the determinants of infant mortality at the municipal level and provide an analysis of the factors affecting child health at the individual level. To analyze the mortality rate, we estimate static and dynamic panel data models using four censuses covering the period from 1970 to 2000. The demand for child health, on the other hand, is addressed through a household decision model, estimated using anthropometric data from the 1996 Standard of Living Survey. The results obtained indicate that a rise in sanitation, education and per capita income contributed to the decline of infant mortality in Brazil, with stronger impacts in the long run than in the short run. The fixed effects associated with county characteristics explain the observed dispersion in child mortality rates. The results from the decision model are confirmed by the findings of the mortality model: education, sanitation and poverty are the most important causes of poor child health in Brazil.