West Bengal 1. District- Dakshin Dinajpur Major Observations of Regional Evaluation Team, Kolkata About the Evaluation Work in D
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West Bengal 1. District- Dakshin Dinajpur Major observations of Regional Evaluation Team, Kolkata about the Evaluation work in Dakshin Dinajpur of West Bengal in July, 2009 respectively I. Details of the visited Institutions: District BPHCs/RH and DCH visited SCs visited visited Dakshin BPHCs: Kushmandi, Kumarganj and Kushmandi, Kalikamora, Balupara, Dinajpur Tapan Mahipur, Kajibag and Bishnupur II. Major Observations: 1. Function of Rogi Kalyan Samittee: a. 27 Rogi Kalyan Samittees have been constituted at all the institutions in the district. b. The regular meetings of Rogi Kalyan Samittee were being conducted as per norms. 2. Services of ASHA: a. 990 ASHAs have been selected and out of that 333 ASHAs have been provided with 5th modules of training. b. Drug kits not supplied to the ASHAs. c. Though a good number of ASHAs are functioning in the district, it was observed that the involvement of ASHA was very poor in respect of institutional delivery in the district. There is a scope to improve the achievement in respect of institutional delivery by involving ASHAs. 3. 24 hours delivery Scheme: The scheme was implemented only in one PHC in the district. 4. Utilization of Untied Funds: a. It is observed that untied funds were provided to the HSCs, PHCs and CHCs in the district for 2008-09 and 2009-10. b. Annual maintenance grant was also provided to the centres in the district. c. Funds provided to the CHCs could not be spent by CHCs during 2008-09, thus the whole amount was transferred to the next year. 5. Services of Janani Suraksha Yojana: a. Sufficient funds provided under the scheme and the beneficiaries got the cash benefits. b. 54 JSY beneficiaries were contacted and they expressed their satisfaction towards the services provided under JSY, however PNC visits and proper involvement of ASHA in the programme needs to improve the quality of services. 6. Physical infrastructure (HSC/PHC/CHC) (i) Health Sub Centres: a. Labour room facility, Cupboard for drugs, Delivery table, Mclntsh sheet, Ambu bag/suction, Delivery kit and DDKs were not available at Sub centres at Khusmandi and Kalikamora.EC Pills, Ampicillin capsule, Gentamycin injection and Oxitocin tab were also not available in these centres. b. Similarly, Electricity, Examination table were not available at Kalikamora Sub centre. c. Toilet facility was not available at Sub centre Khusmandi. d. Skilled Birth Attendance training was not provided to the Auxiliary Nurse Midwives of Sub centres at Khusmandi and Kalikamora. (ii) Primary Health Centres (PHCs) and Community Health Centres (CHCs): a. Vitamin- A tablets was not available in all the BPHCs visited. Post of AYUSH Medical officer was not filled at PHCs visited in the district. b. No supply of IFA syrup at BPHC Kusmandi. 7. Opinion of the Community on the Health Services: a. Recently delivered mothers and the mothers having child upto one year of age were interviewed to assess their opinion about the services provided by the ANMs in their area. b. Most of the respondents were satisfied with the activities covered by the ANMs in respect of health services. c. It is observed that the mothers mostly were not aware of contraceptive methods. d. The villagers’ in the area of the PHCs visited were mostly happy with the services provided at PHC level by the Medical officers and other staff, but it is observed that the increased frequency of regular field visit by the concerned M.Os to the villages could improve the delivery of health care services. 8. Reconciliation of the reporting performance: The reported figures under Oral Pills and Nirodh distribution could not be verified due to absence of service register at the PHCs/CHCs visited in the district. Very few cases were recorded against the reported figures in each centre. 9. Registers, records and reports maintained at the visited centres: a. Updated Eligible couple register were being maintained at all the visited institutions except some minor discrepancies. b. Service registers for Sterilization and IUD cases was not found to be maintained properly and updated at any of the PHC/CHC head quarter. c. Oral Pills and Nirodh distribution registers at the performing units were not being maintained properly. d. Post natal care services register needs to be maintained properly at all the centres visited. e. Stock register of contraceptive items was not maintained properly in all the centres visited. f. Short supply of printed registers for family planning, Stock register and Cash book for untied fund etc. was observed at the Sub centres in the district. 10. Miscellaneous observation and suggestions: a. Monitoring and regular supervision which was observed to be lacking can improve the performance and record keeping at all the centres in the district. b. Performance of the family planning acceptors can be increased in the district if more attention is given to meet the unmet needs of community. 2. District- Uttar Dinajpur Major observations of Regional Evaluation Team, Kolkata about the Evaluation work in Uttar Dinajpur of West Bengal in July, 2009 respectively I. Details of the visited Institutions: Uttar Dinajpur RH: Karandighi Gopalpur, Tungidighi, Chavote, BPHC: Itahar Baidar and Subhasganj District Civil Hospital: Raiganj II. Major Observations: 1. Functions of Rogi Kalyan Samittee: a. 30 Rogi Kalyan Samittees have been constituted in all the public health institutes in the district. b. Regular meetings of Rogi Kalyan Samittee are being conducted as per norms. 2. Services of ASHA: a. It has been reported that out of 804 ASHAs selected in the district, 717 are in position in the villages. 349 ASHAs were reported to have been provided training 5th modules. b. Drug kits not supplied to the ASHAs. c. It was also observed that the role of ASHA to promote institutional delivery particularly in JSY was almost nil. 3. Untied Funds: a. It is observed that untied fund was provided to the HSCs, PHCs and CHCs in the district for 2008-09 and 2009-10. b. Annual maintenance grant was also provided to the centres in the district. 4. Services of Janani Suraksha Yojana: Sufficient funds provided to the district under the scheme and the beneficiaries were getting all cash benefits. However, supervision needs to be strengthened for proper maintenance of JSY records. 5. Physical infrastructure (HSC/PHC/CHC) (i) Health Sub Centres: a. Labour room facility, Mclntsh sheet, Ambu bag/suction, Delivery kit, Disposable syringes, DDKs, were not available at Sub centres Tungidighi and Gopalpur. b. Similarly, supply of Electricity and Water, Toilet facility and CuT insertion kit were not available at Gopalpur Sub centre. c. The ANMs of sub centres Tungidighi and Gopalpur were not staying at centres headquarter. d. No infrastructure was available for conducting deliveries at sub centre level in the district. Skilled Birth Attendance training not provided to the ANMs. In both Sub centres delivery table along with associated furniture was not available which were essential for such services. e. IEC materials and wall Posters for public awareness was lacking in the centres visited. (ii)PHCs and CHCs: a. Telephone connection, IFA tablets (L & S) / syrup, Vitamin- A tablets/syrup were not available at BPHCs Itahar and Karandighi. b. Oxygen cylinder, Functional OT table and Vaccine vials of OPV were not provided at BPHC Karandighi. c. Similarly, Resuscitation equipment, CuT insertion kit and Emergency tray were not available at BPHC Itahar. d. Short supply of Contraceptive items was also observed since last two years in the district. e. Jeep, Weighing machine for infant, Microscope, Lab equipment, X-ray machine, Blood storage unit, Auto clave and Oxygen cylinder were not available at District Hospital Raiganj. 6. Opinion of the Community on the Health Services: a. Mothers having child upto one year old were interviewed to assess opinion about the services provided by ANMs of sub centres at Tungidighi and Gopalpur. b. Most of the respondents were satisfied with the services rendered by ANMs. c. Mothers need to be made aware of proper contraceptive use and also the Health facilities from where they can get all referral health services. d. Post natal care as stated by the mothers need to improve in the visited area. e. The villagers’ in the area of the PHCs visited were happy with the services provided at PHC level by the Medical officers and other staff. Regular field visit by the concerned M.Os to the villages could improve health care delivery further in these centres. 7. Reconciliation of the reporting performance: a. Performance reported by District office for RH at Karandighi, D.H. Raiganj and BPHC at Itahar for sterilisation and CuT cases for the year 2008-09 did not tally with the figures reported by the individual centres/ Institutions for the same period. Similarly, the recorded cases in the service registers were also not maching to the reported figures at RH Karandighi and BPHC at Itahar. b. The performance report received in the district is shown varying the figures as below- Sr. Name of the Sterilizations reported by CuT reported by No. Centres District Reporting Recorded District Reporting Recorded office Centres in registers office Centres in registers 1 D.H. Raiganj 3704 3893 3893 7 7 7 2 RH Karandigh585 756 227 343 340 12 3 BPHC Itahar 879 877 880 144 139 109 c. The reported figures under CuT could not be verified for both 2008-09 and 2009-10 due to absence of completed service register at the head quarter of BPHCs/DH/RH visited in the district. Very few cases were recorded against the reported figures in each centre visited. 8. Registers, records and reports maintained at the visited centres: a. Updated Eligible couple register were being maintained at all the visited institutions except some minor discrepancies.