Inequities in coverage of preventive child health interventions: the rural drinking water supply program and the universal immunization program in Rajasthan, India.
OBJECTIVE
I assessed whether the Rural Drinking Water Supply Program (RDWSP) and the Universal Immunization Program (UIP) have achieved equitable coverage in Rajasthan, India, and explored program characteristics that affect equitable coverage of preventive health interventions.


METHODS
A total of 2460 children presenting at 12 primary health facilities in one district of Rajasthan were enrolled and classified into economic quartiles based on possession of assets. Immunization coverage and prime source of drinking water were compared across quartiles.


RESULTS
A higher access to piped water by wealthier families (P< .001) was compensated by higher access to hand pumps by poorer families (P<.001), resulting in equal access to a safe source (P=.9). Immunization coverage was inequitable, favoring the wealthier children (P<.001).


CONCLUSIONS
The RDWSP has achieved equitable coverage, while UIP coverage remains highly inequitable. Programs can make coverage more equitable by formulating explicit objectives to ensure physical access to all, promoting the intervention's demand by the poor, and enhancing the support and monitoring of frontline workers who deliver these interventions.
Mohan
Pavitra
P
UNICEF Rajasthan, B-9 Bhawani Singh Road, Jaipur-302001, Rajasthan, India. smohanp@sancharnet.in
D002648:Child; D002669:Child Welfare / Q000191:economics*; D002675:Child, Preschool; D006293:Health Promotion; D006801:Humans; D017589:Immunization Programs / Q000600:supply & distribution*; D007194:India; D007223:Infant; D011314:Preventive Health Services / Q000600:supply & distribution*; D015397:Program Evaluation; D019035:Rural Health Services / Q000600:supply & distribution*; D012923:Social Class; D012935:Social Justice; D012959:Socioeconomic Factors; D014881:Water Supply / Q000592:standards*