9th September, 2013 to 19th September, 2013 Rapid Assessment District Hisar Facility Readiness Assessment for Essential Newborn Care and Resuscitation Child Health Division, NRHM, Haryana in technical collaboration with Table of Contents Sr. No. Content Page No. 1. Objectives 2 2. Materials and Methods 2 3. List of facilities visited 2-3 4. General findings of District 3-4 4a. Overall Training Status 4 4b. Status of Newborn Corners 4 4c. Availability of equipment and instruments in NBCC 4 4d. Status of NBSUs 5 5. Quantitative findings of facilities 6-10 6. Qualitative findings of facilities 6 a. General Hospital, Hisar 10 6 b. General Hospital, Hansi 11 6 c. General Hospital, Adampur 11 6 d. CHC Aryanagar 12 6 e. PHC Balsmand 12-13 6 f. PHC Chaudhriwas 13 6 g. PHC Gawar 13-14 6 h. PHC Satrod Kalan 14 6 i. CHC Barwala 14 6 j. PHC Agroha 14 6 k. PHC Dhansu 15 6 l. PHC Landri 15 6 m. CHC Mangali 15-16 6 n. PHC Kaimri 16 6 o. PHC Ladwa 16 6 p. PHC Nalwa 16 6 q. PHC Talwandi Rukka 16-17 6 r. CHC Narnaund 17 6 s. PHC Khanda kheri 17 6 t. PHC Mirchpur 17 6 u. PHC Thurana 17 6 v. CHC Siswal 17 6 w. PHC Chuli Bagarian 17-18 6 x. PHC Dobhi 18 6 y. PHC Kajlan 18 6 z. PHC Neoli Kalan 18 6 aa. CHC Sisai 19 6 ab. PHC Data 19 6 ac. PHC Gurana 19-20 6 ad. PHC Umra 20 6 ae. CHC Sorkhi 21 6 af. PHC Baas 21 6 ag. PHC Puthi Saimain 21 6 ah. PHC Puthi Mangal Khan 21 6 ai. CHC Uklana 22 6 aj. PHC Daulatpur 22 6 ak. PHC Hasangarh 22-23 6 al. PHC Pabra 23 6 am. URCH Azadnagar 23 1 | P a g e 1. Objectives: 1. Qualitative and quantitative assessment of readiness of our health facilities for essential newborn care and resuscitation. 2. To assess the quality of essential newborn care provided to each and every neonate immediately after birth. 3. To understand the existing knowledge, skills, attitudes and practices of the health service providers. 4. On the job trainings to the service providers on novelties in essential newborn care and resuscitation. 2. Materials and Methods 1. A structured and tested assessment tool has been used to assess the facilities on 8 parameters viz. facility identification and infrastructure, availability of services, human resource, Equipment and supplies, Register and client case records, protocols and guidelines, individual case records, knowledge and practices. 2. Knowledge and skill assessment has been done on the newborn simulators (mannequins). 3. The current and ideal practices in essential newborn care and resuscitation have been demonstrated to the service providers on the mannequins. Our teams visited 39 facilities in the district, from 9th September, 2013 to 19th September, 2013, including General Hospitals, all CHCs and PHCs and the delivery huts with monthly delivery load of 3 or more. Following is the list of facilities visited: Sr. No. Name of Facility 1. General Hospital, Hisar 2. General Hospital, Hansi 3. General Hospital, Adampur 4. CHC Aryanagar 5. PHC Balsmand 6. PHC Chaudhriwas 7. PHC Gawar 8. PHC Satrod Kalan 9. CHC Barwala 10. PHC Agroha 11. PHC Dhansu 12. PHC Landhri 13. CHC Mangali 14. PHC Kaimri 15. PHC Ladwa 16. PHC Nalwa 17. PHC Talwandi Rukka 18. CHC Narnaund 19. PHC Khanda kheri 20. PHC Mirchpur 21. PHC Thurana 22. CHC Siswal 2 | P a g e 23. PHC Neoli Kalan 24. PHC Kajlan 25. PHC Dobhi 26. PHC Chuli Bagarian 27. CHC Sisai 28. PHC Data 29. PHC Gurana 30. PHC Umra 31. CHC Sorkhi 32. PHC Puthi Saimain 33. PHC Puthi Mangal Khan 34. PHC Baas 35. CHC Uklana 36. PHC Daulatpur 37. PHC Hasangarh 38. PHC Pabra 39. URCH Azadnagar 3. The findings of district Hisar in general are as follows: • Well established referral linkages at the time of delivery (Higher centers are catering mainly high risk deliveries). • Availability of staff (including medical officers) and attendants (Nursing staff) in most of the facilities. • New born care corners (NBCC) established in almost all the labour rooms. • Availability of reasonable number of trained staff in NSSK and IMNCI. • At birth immunization in many facilities. • Availability of resuscitation equipment in many facilities. • PHCs with availability of generators and 24*7 backup supply. • Availability of running water and toilets in the facilities. • Registers and records maintained in most of the facilities (Case sheets with uniformly printed formats). • Availability of Gynecologists in SDHs and CHCs. • Many birth attendants not trained in SBA. • Hand washing stations not appropriate for effective hand washing. Effective hand washing before delivery not followed. • Simplified Partographs not available in many facilities. • Partographs maintained in many facilities but method is not correct and in most cases these are filled after delivery for record completion. • Autoclave available but not used in some facilities. • Home deliveries in some areas of the district due to unavailability of 24*7 services in some PHCs. • Birth preparedness before delivery not done in some facilities. • Labour room protocols for infection prevention not followed in routine. 3 | P a g e • Case sheets do not have records of essential newborn care. • Suction of every new born in practice despite good cry. • Immediate cord cutting in practice. • Infection prevention and hygiene protocols for labour room and NBCC are not followed in majority of the facilities. • Bag and Mask used for resuscitation. Chronology of resuscitation is not clear (PSSR not followed). Steps are not in chronological order (Resuscitation equipment are not available) • Use of Bag and Mask not appropriate. • Regular refresher trainings needed for resuscitation. • AMTSL practices are not followed in some facilities. • Skin to skin contact not in practice. • Use of Radiant Warmer and separation of every newborn from mother is in practice. • Skills of essential newborn care lacking. • Immediate drying not followed in many facilities • Management of low birth weight babies not done as per protocols 4 a. Overall Training Status Sr. No. No. of Birth attendants SBA NSSK IMNCI 1. 204 113 167 135 4 b. Status of Newborn Corners Newborn Corners Newborn Total NBCCs NBCCs still not with Radiant Corners with Established established Warmer 200 W bulb 36 (39) (No labour 19 37 (18 with both One (Recently shifted to room in Mirchpur) Bulb and warmer) new building URCH Azadnagar) 4 c. Availability of equipment and instruments in NBCCs (n=39) Sr. No. Equipment/Instrument Available (No. of Not available (No. Facilities) of Facilities) 1. Self-Inflating Bag 39 0 2. Mask Size ‘1’ 38 1(Gawar) 4 | P a g e 3. Mask Size ‘0’ 35 (4) Choudhriwas GH Hisar (LR) Talwandi rukka Daulatpur 4. Shoulder Roll 38 1 5. Suction Catheter 37 2 (Pabra and Sisai) 6. Disposable Mucus Extractors 37 2 (Puthi Samain, Suryanagar) 7. Suction Machine 39 0 8. Oxygen Cyinder 37 2 (URCH Azadnagar and Suryanagar) 9. Baby Sheets 38 1 (Balsamand) 10. NBCC at appropriate place 33 6 (changes suggested on site) 4 d. Status of Designated Newborn Stabilization Units (NBSUs) Sr. No. Name of Status Functionality No. of Radiant No. of Institution Warmers Phototherapy Units 1. SDH Hansi Established Not Functional 1 1 2. CHC Barwala Not NA Only in NBCC 0 Established 3. CHC Mangali Not NA Only in NBCC 1 Established 4. CHC Uklana Not NA Only in NBCC 1 Established 5. CHC Aryanagar Not NA Only in NBCC 1 Established 5 | P a g e 4. Quantitative Analysis of various facilities (n= 37) Score 75% and Above Score 51% to 74% Score 50% and less Registers Knowledge Delivery And Essential Drugs, Provider And Facility’s Name Of Protocols And About Infrastructure Newborn Care Equipment And Knowledge Client Overall Facility Guidelines Infection Services Supplies And Skills Case Average Prevention Records CHC Barwala 85 78 87 80 57 66 75 75 PHC Chuli 69 89 79 70 57 70 75 73 Bagrian PHC Landri 79 83 72 70 71 72 61 73 PHC Nalwa 98 89 77 50 71 46 69 71 PHC Putty 75 89 82 70 71 39 67 71 Mangal Khan CHC Mangali 67 72 72 70 57 65 73 68 PHC Khanda 88 78 80 60 57 54 58 68 Kheri GH Hisar 63 89 84 70 57 59 50 67 GH Hansi 67 89 80 70 57 52 56 67 CHC 71 72 74 60 57 66 66 67 Narnaud SDH 87 83 74 80 29 61 50 66 Adampur PHC Ladwa 75 83 79 80 29 55 59 66 CHC Sorkhi 79 89 71 70 43 49 56 65 PHC 81 83 74 60 43 46 62 64 Neolikalan PHC Sisai 81 89 60 60 43 61 49 63 PHC Agroha 65 78 76 80 29 57 55 63 PHC Gurana 77 83 72 90 14 53 47 62 PHC Kaimri 81 78 66 70 43 46 52 62 6 | P a g e CHC Arya 81 89 79 60 14 48 61 62 Nagar PHC Bass 63 89 81 60 29 39 66 61 PHC Dobi 42 83 74 80 43 45 57 61 DISTRICT 72 82 73 64 36 51 49 61 AVERAGE PHC Datta 65 83 70 90 14 50 47 60 PHC Satrod 52 78 79 60 43 55 50 60 Kalan PHC Dhansu 69 83 68 60 29 48 56 59 PHC Kajlan 48 83 80 50 29 57 57 58 PHC Pabra 73 83 60 40 43 50 52 57 PHC 88 78 64 50 29 37 41 55 Hassangarh PHC 75 83 73 60 29 31 36 55 Puthisamain PHC Umra 67 72 73 60 29 46 28 54 CHC Uklana 71 94 70 50 0 44 46 54 PHC 69 83 60 50 14 46 48 53 Daulatpur PHC 77 83 60 40 14 43 51 53 Talwandi PHC 62 72 61 60 29 45 36 52 Balsamand PHC Gawar 75 72 65 60 14 50 6 49 PHC 71 67 66 60 29 50 0 49 Chaudhariwas PHC Thurana 79 78 72 60 0 33 7 47 URCH Azad 58 78 73 60 0 40 0 44 Nagar 7 | P a g e Graph 1.