Challenges, Barriers, and Good Practices in the Implementation of Rashtriya Bal Swasthya Karyakram in Jodhpur, India

Abstract

Introduction The Rashtriya Bal Swasthya Karyakram of the Government of India subsumes the existing school health program to provide care and treatment to children below 18 years through screening and early interventions. Benefitting an estimated 270 million children for 30 preidentified conditions is a step toward “health for all.” Although the program is running since 2013, due to paucity of studies particularly in Thar desert region and its associated challenges, this study was planned to assess challenges and good practices in the implementation of RBSK in Jodhpur.
Objectives To assess the challenges, barriers, and good practices in the implementation of RBSK among the mobile health team (MHT) in Jodhpur, Rajasthan.
Methods A community based descriptive cross-sectional study in all 11 medical blocks of Jodhpur district, with purposive sampling to invite all members of MHT to participate in the study as grassroot workers was planned. A pretested, semistructured questionnaire was processed using SPSS for quantitative component and in-depth interviews were reported using qualifiers for qualitative observations.
Results As much as 74.1% (n = 40) of the staff perceived the trainings to be sufficient for daily work needs but needed more sessions for birth defects (33.3%) and development delays (29.6%). As much as 96.3% (n = 52) of the staff considered salaries to be low and 55.5% were dissatisfied with the jobs. However, 70.4% found targets to be achievable and 76% found the work environment helpful. Taboos and superstitions in community, harsh climate, dual workload on pharmacists as data operators, and noninclusion of AYUSH medicines for AYUSH medical officers (MOs) were few of the challenges, while good practices such as fully equipped MHTs, readily available vehicles, information education communication (IEC) materials, and treatment coverage under Bhamashah Bima Yojana (BSBY) were also observed.
Conclusion Many good practices were observed during the study which can be adopted by other states for better implementations elsewhere. Certain challenges such as belief in quackery, superstitions and taboos could be minimized by conducting rapport-building meetings with community stakeholders. Feedback and regular trainings of MHT staff can further increase the success manifold.

Full text

THIEME
237
Original Article
Challenges, Barriers, and Good Practices in the
Implementation of Rashtriya Bal Swasthya Karyakram
in Jodhpur, India
Niraj Kumar1 Nitin Kumar Joshi1 Yogesh Kumar Jain1, Kuldeep Singh1 Pankaj Bhardwaj2
Praveen Suthar1 Balwant Manda3 Ravi Kirti4
1School of Public Health, All India Institute of Medical Sciences,
Jodhpur, Rajasthan, India
2Department of Community Medicine and Family Medicine, School
of Public Health, All India Institute of Medical Sciences, Jodhpur,
Rajasthan, India
3Chief Medical and Health Officer, Jodhpur, Rajasthan, India
4District Early Intervention Centers, Rashtriya Bal Swasthya
Karyakram, Jodhpur, Rajasthan, India
published online
October 26, 2021
Address for correspondence Pankaj Bhardwaj, MBBS, MD,
Department of Community Medicine and Family Medicine, School of
Public Health, All India Institute of Medical Sciences, Basni Phase–II,
Jodhpur, Rajasthan 342 005, India
(e-mail: pankajbhardwajdr@gmail.com).
Introduction The Rashtriya Bal Swasthya Karyakram of the Government of India
subsumes the existing school health program to provide care and treatment to
children below 18 years through screening and early interventions. Benefitting an
estimated 270 million children for 30 preidentified conditions is a step toward “health
for all.” Although the program is running since 2013, due to paucity of studies partic-
ularly in Thar desert region and its associated challenges, this study was planned to
assess challenges and good practices in the implementation of RBSK in Jodhpur.
Objectives To assess the challenges, barriers, and good practices in the implementa-
tion of RBSK among the mobile health team (MHT) in Jodhpur, Rajasthan.
Methods A community based descriptive cross-sectional study in all 11 medical
blocks of Jodhpur district, with purposive sampling to invite all members of MHT to
participate in the study as grassroot workers was planned. A pretested, semistructured
questionnaire was processed using SPSS for quantitative component and in-depth
interviews were reported using qualifiers for qualitative observations.
Results As much as 74.1% (n = 40) of the staff perceived the trainings to be sufficient
for daily work needs but needed more sessions for birth defects (33.3%) and devel-
opment delays (29.6%). As much as 96.3% (n = 52) of the staff considered salaries to
be low and 55.5% were dissatisfied with the jobs. However, 70.4% found targets to be
achievable and 76% found the work environment helpful. Taboos and superstitions in
community, harsh climate, dual workload on pharmacists as data operators, and non-
inclusion of AYUSH medicines for AYUSH medical officers (MOs) were few of the chal-
lenges, while good practices such as fully equipped MHTs, readily available vehicles,
information education communication (IEC) materials, and treatment coverage under
Bhamashah Bima Yojana (BSBY) were also observed.
Abstract
DOI https://doi.org/
10.1055/s-0041-1739032
ISSN 0379-038X
© 2021. National Academy of Medical Sciences (India).
This is an open access article published by Thieme under the terms of the Creative
Commons Attribution-NonDerivative-NonCommercial-License, permitting copying
and reproduction so long as the original work is given appropriate credit. Contents
may not be used for commercial purposes, or adapted, remixed, transformed or
built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor,
Sector 2, Noida-201301 UP, India
Ann Natl Acad Med Sci (India) 2021;57:237–243.
Keywords
►RBSK
►challenges
►barriers
►implementation
►Rajasthan
Article published online: 2021-10-26

238
Annals of the National Academy of Medical Sciences (India) Vol. 57 No. 4/2021 © 2021. National Academy of Medical Sciences (India).
Implementation of Rashtriya Bal Swasthya Karyakram Kumar et al.
Introduction
The Rashtriya Bal Swasthya Karyakram (RBSK) is an innova-
tive and ambitious initiative of the Ministry of Health and
Family Welfare, Government of India.1 Launched under the
National Health Mission, this initiative subsumes the exist-
ing school health program and envisions child health screen-
ing and early intervention services to provide care, support,
and treatment to children.2 Child health screening and early
intervention services refer to early detection and manage-
ment of a set of 30 preidentified health conditions such as
birth defects, deficiency conditions, and developmental
delays including disabilities (4Ds) that are prevalent in chil-
dren of less than 18 years of age.3
In India, out of every 100 live births, 6 to 7 have birth
defects, which translate to 1.7 million birth defects annu-
ally and lead to 9.9% of all newborn deaths.456 Development
delays are common in early childhood, affecting at least 10%
of the children.7 If not intervened in a timely manner, these
delays may lead to permanent disabilities, resulting in cogni-
tion imbalance and hearing and vision disabilities.8910 With
an aim to reduce the extent of disability and improve the
quality of life through health screening and early interven-
tions, this program is aimed to be a step toward “health for
all,” benefitting an estimated 270 million children between
age of 0 to 18 years attending Anganwadi centers and gov-
ernment schools.9
Although the RBSK program has been running in the coun-
try since 2013, there is a paucity of studies on RBSK, partic-
ularly in this part of the country, which comes in with the
additional challenges associated with the remotely located
areas of the Thar desert. Moreover, the few studies that have
been conducted in the context of RBSK are only knowledge,
attitudes and beliefs, and practices (KAP) based. It is evident
from these studies that the health team deployed under
any project or program faces varied challenges and barriers
related to the work conditions such as cooperation, support,
resistance from community, and burden of work.111213
The task taken up in the program is quite enormous but
possible nevertheless. Only through a systematic approach
and implementation, rich dividends in protecting and pro-
moting the health of the children can be achieved.
Challenges and barriers affect the progress of any pro-
gram, and if these factors are identified, then measures could
be planned to overcome them for betterment. Every program
has some good practices as well, which reveal the progress
of the program, and are necessary to be identified, as these
could be adopted ubiquitously for the beneficence of the ben-
eficiaries and providers.
Keeping the above in mind, this study was planned to
assess the challenges, barriers, and good practices in imple-
mentation of RBSK program.
Objectives
• To assess the challenges and barriers for implementation
of RBSK among the mobile health team (MHT) in Jodhpur.
• To assess the good practices for implementation of RBSK
among the MHT in Jodhpur
Methods
A community-based descriptive cross-sectional study was
planned in 11 medical blocks of Jodhpur district of Rajasthan,
India. The MHT was taken as primary unit of study, since an
MHT works at the grassroot level for the implementation of
this program.
Purposive sampling was used and all the members of
the MHT of all 11 medical blocks were invited to partici-
pate in the study. Ayurveda, Yoga and Naturopathy, Unani,
Siddha and Homeopathy (AYUSH) medical officers, auxiliary
nurse midwives (ANMs), and pharmacists of the MHT were
included, and those who were on maternity, casual or medi-
cal leaves were excluded.
For the quantitative component, a semistructured ques-
tionnaire was used, based on the formative research report of
RBSK, Assam, while for the qualitative component, in-depth
interviews of the members of MHT were conducted. The
questionnaire comprised questions related to manpower,
sociodemographic information, perception regarding train-
ings, support and resistance from officials and community,
and challenges faced by the teams. The data collection was
done at the time of visit to individual blocks by the inter-
viewer, and data pertaining to the manpower, equipment,
transport facilities and good practices were noted through
observations. Data related to satisfaction, perception about
trainings, resistance from community, and support from the
officials were recorded along with the demographic details
from all the staff members present on the day of visit through
the interviews and questionnaire. Quantitative data was pro-
cessed using SPSS software and qualitative observation were
presented in semiquantitative form using qualifiers.
Conclusion Many good practices were observed during the study which can be
adopted by other states for better implementations elsewhere. Certain challenges
such as belief in quackery, superstitions and taboos could be minimized by conducting
rapport-building meetings with community stakeholders. Feedback and regular train-
ings of MHT staff can further increase the success manifold.

239Implementation of Rashtriya Bal Swasthya Karyakram Kumar et al.
Annals of the National Academy of Medical Sciences (India) Vol. 57 No. 4/2021 © 2021. National Academy of Medical Sciences (India).
Results and Observations
Under the RBSK program, children of age 6 to 18 years are
screened in government and government-aided schools,
with the block serving as the hub of all activities, and villages
in the jurisdiction of the block distributed among the MHTs.
At least three dedicated MHTs in each block were engaged
to conduct the screening, and the number of teams varied,
depending upon the number of Anganwadi centers, remote-
ness and number of children enrolled in the schools.
Every MHT is composed of 2 AYUSH medical officers
(1 male and 1 female), 1 ANM or staff nurse, and 1 pharmacist
having proficiency in computers for additional task of data
management. Screening was found to be conducted at least
twice a year in children enrolled in Anganwadi centers and at
least once a year for school children.
A toolkit with essential equipment for screening of chil-
dren was provided to the MHT members, including equip-
ment for screening of development delays: bell, rattle, torch,
one-inch cubes, bottle with resins, squeaky toys and col-
ored wool (for 6 weeks–6 years) and vision charts, reference
charts, blood pressure (BP) apparatus with age-appropriate
cuffs (for 6 years–18 years). Age-appropriate anthropom-
etry equipment such as weighing scales, height-measuring
stadiometers, and tapes and bangles for midarm circumfer-
ence and head circumference were also found along with a
development checklist to record milestones for identification
of developmental delays. Vehicles were hired for movement
to different locations (Anganwadi centers, government and
government-aided schools).
Every MHT prepared a microplan prior to a visit to
Anganwadi and schools, considering route chart for daywise
visits, logistics management, reporting system, and identifi-
cation of all relevant stakeholders.
The in charge medical officer (MO) of the block takes the
lead in the microplanning process and is supported by mem-
bers of the mobile team and local health staff. In urban areas,
the district chief MO designates a nodal hospital/dispensary
with a key-in-charge staff for overseeing the activities and
preparing microplans related to RBSK.
Socio Demographic Information
Out of the total participants (n = 54) surveyed from 11 medical
blocks of Jodhpur, 44 were female, and majority of partici-
pants (57.4%) were of age group between 30 to 40 years in this
survey. Among all participants, there were 32 medical offi-
cers, 11 ANMs, and 11 pharmacists. Mean salary of the MOs,
ANMs, and pharmacists were Rs. 17,061 ± 374.51, Rs. 6,075 ±
386.70, and Rs. 8,314 ± 412.61, respectively (►Table1).
Challenges and Barriers Faced by the Members of MHTs
Majority of the MOs (90.6%; n = 29) agreed that training pro-
vided to them through RBSK was sufficient to carry out the
screening activities and overcome the field challenges, while
only 36.4% (n = 4) of ANMs agreed with the same. On the
other hand, all MOs (n = 32) and pharmacists (n = 11) con-
sidered that their salary was not in accordance with the des-
ignation and workload. MHT staff agreed that more training
sessions were required for screening and management of
issues related to defects at birth and development delays and
disabilities (►Table2).
As much as 78.1% of the MOs and 72.7% ANMs perceived
the targets provided to them to be achievable, but the per-
ception was not so among the pharmacists, 54.5% of whom
considered the targets to be unachievable.
Most of the MOs (62.5%) and pharmacists (72.8%) did not
seem satisfied with their job, whereas 81.8% ANMs were
found to be satisfied; 75% MOs, 90.9% ANMs and 63.6% phar-
macists perceived the work atmosphere at screening camp
helpful and mutually cooperative. Nevertheless, majority of
the MHT staff (68.8% MO, 63.6% ANMs and 63.6% pharma-
cists) shared experiences of facing resistance from the com-
munity during screening camps.
Other challenges that were brought forward during the
interviews were those of harsh climatic conditions, difficult
terrain and inaccessible areas, and prevalence of supersti-
tions among villagers and tribes.
Adverse working conditions:
“Most of the time during our work, temperature is
too high.”
“Areas adjacent to the Thar desert have extremely
high temperatures, which do not allow us to work
with full potential.”
Superstitions and local practices:
Caregivers were reported to be not ready for treatment of
their children even when the government provided it free of
cost; instead, they made different excuses and were reluc-
tant for availing treatment or suggestions provided by the
RBSK team.
“Superstition prevails among the villagers at vari-
ous levels, few villagers think that tantriks can treat
disease better than the doctors, they consider every-
thing (deeds and spirits) and not just our illness.”
Table 1 Showing demographic characteristics of the
participants surveyed from 11 medical blocks of Jodhpur
Characteristics n = 54 %
Age
20–30 19 35.19
30–40 31 57.41
40-above 4 7.40
Gender
Male 30 55.46
Female 24 44.44
Post Prole
MO 32 59.3
ANM 11 20.4
Pharmacist 11 20.4
Abbreviations: ANM, auxiliary nurse midwife; MO, medical officer.

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Annals of the National Academy of Medical Sciences (India) Vol. 57 No. 4/2021 © 2021. National Academy of Medical Sciences (India).
Implementation of Rashtriya Bal Swasthya Karyakram Kumar et al.
Table 2 Showing perception of participants regarding various issues
MHT staff Tot al
(n = 54)
MO
(n = 32)
ANM
(n = 11)
Pharmacist
(n = 11)
Perception regarding
RBSK training fulll-
ing daily work needs
Strongly agree
% (n)
28.1 (9) 0 (0) 18.2 (2) 20.4 (11)
Agree
% (n)
62.5 (20) 36.4 (4) 45.5 (5) 53.7 (29)
Neutral
% (n)
3.1 (1) 18.2 (2) 9.1 (1) 7.4 (4)
Disagree
% (n)
3.1 (1) 27.3 (3) 18.2 (2) 11.1 (6)
Strongly Disagree
% (n)
3.1 (1) 18.2 (2) 9.1 (1) 7.4 (4)
Perception regarding
need for more
training session for
dierent diseases
Defects at birth
% (n)
37.5 (12) 27.3 (3) 27.3 (3) 33.3 (18)
Deciencies
% (n)
9.4 (3) 0 (0) 0 (0) 5.6 (3)
Childhood disease
% (n)
18.8 (6) 0 (0) 9.1 (1) 13 (7)
Development delays and
disabilities % (n)
31.3 (10) 18.2 (2) 36.4 (4) 29.6 (16)
Others
% (n)
3.1 (1) 54.5 (6) 27.3 (3) 18.5 (10)
Perception of
respondents regard-
ing salary
Satisfactory
% (n)
0 (0) 18.2 (2) 0 (0) 3.7 (2)
Unsatisfactory
% (n)
81.3 (26) 36.4 (4) 63.6 (7) 68.5 (37)
Very low
% (n)
18.8 (6) 45.5 (5) 36.4 (4) 27.8 (15)
Perception regarding
job satisfaction and
future prospects
Stay in same job
% (n)
6.3 (2) 27.3 (3) 18.2 (2) 13 (7)
Job is promising
% (n)
31.3 (10) 54.5 (6) 9.1 (1) 31.5 (17)
Dissatised
% (n)
46.9 (15) 18.2 (2) 45.5 (5) 40.7 (22)
Leave as soon as possible
% (n)
15.6 (5) 0 (0) 27.3 (3) 14.8 (8)
Perception regarding
provided targets
Achievable
% (n)
78.1 (25) 72.7 (8) 45.5 (5) 70.4 (38)
Not achievable
% (n)
18.8 (6) 27.3 (3) 54.5 (6) 27.8 (15)
Achievable but quality
suers
% (n)
3.1 (1) 0 (0) 0 (0) 1.9 (1)
Perception about
atmosphere at
screening camp
Helpful
% (n)
75 (24) 90.9 (10) 63.6 (7) 76 (41)
Neutral
% (n)
12.5 (4) 9.1 (1) 27.3 (3) 14.8 (8)
Noncooperative
% (n)
12.5 (4) 0 (0) 9.1 (1) 9.3 (5)
Perception about
resistance from
community
Always
% (n)
0 (0) 9.1 (1) 0 (0) 1.9 (1)
Sometimes
% (n)
68.8 (22) 54.5 (6) 63.6 (7) 64.8 (35)
Not at all
% (n)
31.3 (10) 36.4 (4) 36.4 (4) 33.3 (18)
Abbreviations: ANM, auxiliary nurse midwife; MHT, mobile health team; MO, medical officer.

241Implementation of Rashtriya Bal Swasthya Karyakram Kumar et al.
Annals of the National Academy of Medical Sciences (India) Vol. 57 No. 4/2021 © 2021. National Academy of Medical Sciences (India).
“Diseases and deformities, according to the rural
caregivers, is a curse of their past life deeds”
Manpower:
Certain MHTs reported to be deficient in human resources
and thus unable to meet targets repeatedly.
“We do not have sufficient manpower required
for our block size, so we are missing deadlines
repeatedly.”
“We have MOs but not sufficient data entry opera-
tors and nurses, so our reporting is often delayed.”
Transport facilities:
Proper roads for transportation seemed to be lacking in
most of the remote villages, and the RBSK team considered
it to be one of the major issues against reaching out to max-
imum population.
“Sometimes, team needs to walk a long distance
to reach remotely located Anganwadi centers and
schools.”
“Many times, RBSK vehicles cannot cross diffi-
cult terrains, and we have to walk to reach our
destination.”
Support from Anganwadi centers:
In some instances, support from Anganwadi center was
lacking. In such Anganwadis, attendance of children was low
during the screening camp.
“Few Anganwadi workers do not take interest in
RBSK program, and when forced, they bring unreg-
istered children to increase the attendance at RBSK
screening camp.”
Salary and renumeration:
While taking in-depth interviews, most of the MOs had
concerns about their salary.
“Our salary is very low as compared to other states’
RBSK Mos.”
“Considering the workload, salary should be simi-
lar to permanent MOs.”
AYUSH medicines:
Majority of MOs were of view that AYUSH medicine
should be incorporated in medicine kit, as MHT MOs were
from AYUSH background.
“AYUSH medicine are very effective in childhood dis-
eases and should be provided along with allopathy.”
“Authorities should provide provision of AYUSH
system of medicines in the medicine kit.”
Good Practices
Along with the challenges and barriers, certain good prac-
tices were also observed in the implementation of RBSK by
various MHTs during the course of study, such as fully func-
tional and adequately equipped MHTs of RBSK Jodhpur along
with appropriate vehicles that were readily available and
maintained prior to every field visit. Most of the MHTs were
found to be able in providing information education commu-
nication (IEC) for creating awareness during screening camps
related to newborn diseases and healthy lifestyles.
In the state of Rajasthan, Bhamashah Bima Yojana (BSBY)
covers RBSK surgical cost of the patient, which was found
to be able to provide for better patient compliance, cover-
age and acceptability. At the level of data collection, most of
the screened data was sent to the district early intervention
center (DEIC) through an online portal, which made the data
entry transparent and rapid with limited errors.
Discussion
The RBSK project was launched in February 2013 with the
objectives of early detection and management of the 4Ds,
and in this study, we tried to assess challenges, barriers, and
good practices in center so far toward achieving this objective
of RBSK in Jodhpur, Rajasthan.
It was evident in this study that RBSK team is getting
supportive environment for their work in communities, but
myths and misconceptions of the rural community were
posing major challenges to their functioning. Education and
sensitization with reinforcement could help to overcome this
barrier.
In the present study, findings revealed that MHT of med-
ical block (Baap, Phalodi, and Balesar) were deficient in
human resources required to complete the target. Most of the
medical officers were from Ayurvedic (Bachelor of Ayurvedic
Medicine and Surgery [BAMS]) background and a few from
other streams (Bachelor of Homeopathic Medicine and
Surgery [BHMS], Bachelor of Unani Medicine and Surgery
[BUMS]), but there was a deficiency of data entry operator
and nurses. Similar findings were highlighted in the study
conducted by Singh et al.14
The challenges, barriers, and good practices of all MHTs
of RBSK were assessed using a pretested questionnaire, and
majority of MOs agreed that the training provided by RBSK
fulfils the basic need of organizing screening camps.
It was found in the study that RBSK was successful in
maintaining the satisfaction level of grassroot level team
worker (ANMs), but a contrast was observed in context of
the salaries in the perception of majority of MOs and phar-
macists. The salaries were considered very low compared
with other states where RBSK program is running. Most of
the pharmacists thought that work target provided to them
were not achievable, because they had dual roles of work as
a pharmacist as well as that of a data entry operator. Similar
challenges were reported in the implementation of other
national programs in the country, as highlighted by the stud-
ies conducted by Sogarwal et al and Best and Kumar.15,16

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Annals of the National Academy of Medical Sciences (India) Vol. 57 No. 4/2021 © 2021. National Academy of Medical Sciences (India).
Implementation of Rashtriya Bal Swasthya Karyakram Kumar et al.
Most of the MOs, pharmacists, and ANMs perceived that
atmosphere at screening camp was helpful. However, some-
times, resistance was created by community, and seldom
by school teachers and Anganwadi staff, which affected the
screening program. Furthermore, most of the MOs faced chal-
lenges while convincing caregivers of the children, because
of prevailing superstitions among the villagers, which posed
a major barrier in implementation. Rural caregivers said
that diseases are a curse of their past lives’ deeds, and they
seemed reluctant to avail treatment or suggestions pro-
vided by the RBSK team. Similar challenges in health seeking
behaviors were observed in studies conducted by Sagar et al
and Kaur et al.17,18
Findings from the present study revealed that majority of
MOs viewed that AYUSH medicine should be incorporated in
medicinal kit, as MHT MOs were from AYUSH background,
and they perceived that AYUSH medicines are very effective
in childhood diseases.
While certain good practices such as fully occupied MHTs
of RBSK Jodhpur with screening equipment, availability of
appropriate vehicles for field visits, and ANMs perceived to
be satisfied with their job were seen, nevertheless most of
the MOs and pharmacists were not satisfied with their jobs.
It may be due to the fact that majority of MOs and pharma-
cists considered that their salary was very low compared
with other states running RBSK program.
Conclusion and Recommendations
With this study, we inferred that the certain good practices
as well as many challenges were major determinants in the
achievement of objectives of the ongoing RBSK program.
Lesser salary and dual workload for pharmacists were major
barriers which along with challenges such as harsh weather
conditions, poor terrain, and resistance created by local com-
munity hindered the working up to full potential by the MHT
staff. There is a requirement of more training sessions on
birth defects, and issues such as lack of manpower in certain
blocks need to be addressed.
Through the study, few systematic recommendations are
suggested, which if implied might prove to improve program
implementation. There is a need for an equality in the wages
of MHT staff in comparison with other RBSK running states
and a need for rapport-building activities with community
stakeholders prior to the scheduled screening. Awareness
activities for the community with major involvement of local
stakeholders would be helpful in reducing the community
resistance experienced by MHT staff. Recruitment of ded-
icated data entry operators, responsible for data entry of a
group of MHTs, would further increase the efficiency of the
pharmacists while not straining the budgetary restraints.
Provision of AYUSH medicines in the medicine kit to be used
along with allopathic treatment modalities, provision of air
condition vehicles to combat the harsh weather conditions,
and frequent feedback from MHT staff regarding training
requirements and regular training activities regarding the
same are further expected to increase staff compliance and
ensure program success.
Conict of Interest
None declared.
Acknowledgment
We thank the offices of Chief Medical & Health Officer, Joint
Director Medical & Health Services, Reproductive & Child
Health and Urban Health Planning Consultant of Jodhpur,
Rajasthan, for their invaluable support. Without their
help, this project would not have completed successfully.
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