Manipur 1.District:- Chandel Major observations of Regional Evaluation Team, Kolkata on the Evaluation work carried out in Chandel district of Manipur during the month of August, 2011. I. Details of the visited Institutions: District visited D.H., CHC and PHCs visited SCs visited Chandel DH: Chandel Aimol Thampak, Komla CHC: More Thambi, Unopat and Saivom PHCs: Chakpikarong, Tengnoupal and More II. Major Observations: 1. Health Human Resources: a. No sanctioned strength of the staff was available at district office. At district headquarter no one was aware about the sanctioned strength of staff in the district. b. Acute shortage of Specialists and Medical officers was observed in the visited institutions. 5 posts of Specialist, 4 posts of MO and 4 posts of GNM/Staff Nurse were lying vacant at District Hospital. 3 posts of Specialist, 13 posts of MO, 15 posts of GNM/Staff Nurse were vacant in the Centres of CHC Moreh. c. The PHC Chakpikarong was functioning with single AYUSH, MO. d. Under District Programme Management Unit (DPMU), one post each of District Programme Manager, District Data Manager, Block Account Manager, Block Data Manager and 2 posts of Block Programme Manager were lying vacant since long in the district. 2. Functioning of Rogi Kalyan Samiti (RKS): It was reported that RKS has been constituted and registered in the visited CHC and PHCs in the district, but the meetings of RKS were not being held regularly. 3. Functioning of ASHA and Village Health Sanitation & Nutrition Committee (VHSNCs): a. As targeted, 550 ASHAs have been selected in the district and provided training up to 6th module. 550 ASHAs had been provided drug kits during 2010-11 but no drug kit has been provided to them during the year 2011-12 till the visiting month. b. As reported 542 VHSNCs were functioning in the district and all are having ASHA as a member of the committee. c. Untied funds for VHSNC to the tune of Rs. 67,00,399 including opening balance of Rs. 35,00,399 were available for the year 2010-11 and out of that the amount of Rs. 39,76,150 was utilized by the VHSNCs within the period in the district. Opening balance amounting to Rs. 27,24,249 available in the year 2011-12 was lying unspent till the time visit of the team in the district and no VHSNC Untied fund was provided to the district during current year 2011-12. 4. Services of Janani Suraksha Yojana (JSY): a. Rs. 12,65,800 was spent in the district under the scheme out of an amount of Rs. 13,36,600 available during the year. No fund was released to the district during current year 2011-12 up to the date of visit. b. It was reported that, 1986 and 312 deliveries were identified for JSY payment under the scheme in the year 2010-11 and 2011-12, out of that 1876 and 151 JSY beneficiaries were paid with JSY incentive during last year and current year respectively. c. C - Section delivery facility was not available in the district as a whole. During visit to the centres, it was observed that sufficient funds were not provided in time to the visited facilities. Registers for JSY were maintained properly containing the list of beneficiaries to whom cash had been distributed and registers were checked properly by concerned Medical officer In charge. d. 36 JSY beneficiaries contacted for on the spot verification in the district and it was observed that MCH cards were issued to all of them. Three consecutive ANC checkups was not given to all the beneficiaries. Beneficiaries were not getting incentive amount on the date of discharge due to delay in submitting the cards along with necessary papers to the office of the hospital. 5. 24 hours delivery care services: a. 24 hours delivery care system implemented in 4 institutions i.e. in District Hospital, 1 CHC and 2 PHCs in the district. b. Facility for caring mothers and new born care were found inadequate at most of the visited centres. Blood storage facility was not available at CHC and PHCs visited. Required number of para-medical staff for conducting 24x7 delivery was also not there at the visited facilities. 6. Untied Funds: a. Every CHC, PHC and Sub Centre was being provided funds @ Rs. 50,000, Rs. 25,000 and Rs. 10,000 per year respectively as Untied funds in the district. The position of Untied funds for the year 2010-11 is given below: (In Rs.) Sr. Particulars Opening Fund Expenditure Balance No. Balance Received 1 For CHCs Nil 50,000 Nil 50,000 2 For PHCs 2,22,040 75,000 2,71,540 25,500 3 For Sub Centres 25,47,495 3,60,000 3,35,747 25,71,748 b. Untied Fund released to the visited PHCs/CHC and utilized by them in the year 2010-11 in the district are given below: (in Rupees) Name of Institutions Opening Released Expenditure Balance Balance CHC Moreh Nil 50,000 Nil 50,000 PHC Chakpikarong 25,000 25,000 50,000 Nil PHC Moreh Nil Fund not provided PHC Tengnoupal Record not made available c. No untied fund has been provided to the district for the year 2011-12. d. It was observed that fund was utilized for purchase of Generator, printer, Laboratory items, gas box, stationary and expenditure on Photocopy etc. by the visited PHCs. 7. Physical infrastructure (HSC/PHC/RH) (i) Health Sub Centres: a. The Sub centres visited at Aimol Thampak, Komla Thambi, Unopat and Saivom were not as per IPHS. Labour room facility was available only at Sub Centres Unopat and Saivom. Electricity supply was irregular. No mobile phone has been provided to the ANMs. b. Ambu bag/suction, Steam sterilizer, RDT kits, Heamoglobinometer, DDKs, Santary Napkins, Oxitocine tablets, Kits- A & B and Gentamycin injection were not available at all the visited centres. c. Delivery table, Mclntosh sheet and CuT insertion kit were not available at the Sub Centres Unopat and Saivom. d. ORS packets, Co-trimoxazole tablets, EC Pills and Condoms were not available at Sub Centres Aimol Thampak, Unopat and Saivom. e. Vitamin- A solution and Oral Pills at Sub Centre Aimol Thampak, Delivery kit and Chloroquine tablets at Sub Centre Komla Thambi, CuT and Chloroquine tablets at Sub Centre Unopat and Delivery kit, Vitamin- A solution, Oral Pills and Chloroquine tablets at Sub Centre Saivom were not available on the day of visit. (ii) PHCs/CHC/DH: a. District Hospital at Chandel, CHC at Moreh and PHCs at Chakpikarong, Tengnoupal and Moreh were visited by the team in the district. New building for DH was under construction. Electricity supply in these institutions was irregular. Labour room was not functional at PHCs Tengnoupal and Moreh. b. Blood storage unit, Sick New born Care Unit and Anesthesia equipment were not available at District Hospital Chandel and CHC at Moreh. c. Ambulance, Auto clave and Operation Theatre at District Hospital Chandel and X-ray facility, Resuscitation equipment, Neonatal Resuscitation equipment and CuT insertion kit at CHC Moreh were not available. d. The building of PHC Tengnoupal was in bad condition, entire roof and wall of the building was damaged. Rest of the building was leaking during rain. There was no safe OPD room, ward, labour room, office room, store room, dressing room etc. as a result records, registers, medicine and the equipments were getting damaged. e. Functional Operation Theatre was lacking in the visited PHCs. There was also no Ambulance/ Jeep in these PHCs. f. Telephone facility was not provided to PHCs Chakpikarong and Tengnoupal. Cold chain equipments at PHCs Chakpikarong and Moreh were not available. Oxygen cylinder was not available at PHC Tengnoupal. g. PHC Moreh had a very nice labour room, but deliveries were not conducted there for want of equipments/ instruments. Presently labour room was used for store. 8. Opinion and awareness of the Community on the Health Services: (i). ANMs Services: a. 20 mothers having child up to one year age were interviewed for assessing their opinion and knowledge about the services provided by the concerned ANMs at Sub Centre level. Mothers were satisfied with the services. b. Most of the interviewed mothers were not aware about use of contraceptive and its side effects. Post natal services were also poor in the area of Sub Centres Kamala Thabi and Unopat. (ii). HW (M) Services: Though the villagers in area of Kamala Thabi Sub Centre were satisfied generally with the services of MPW (M), their dissatisfaction was mainly towards not staying of MPW (M) at sub centre headquarters, his irregular visit to the villages and also the services relating to environmental sanitation, group meeting on health topic and STD / HIV/AIDS etc. (iii). Services of PHC: a. In the area of visited PHCs at Chakpikarong and Tengnoupal, the RCH beneficiaries i.e. pregnant women, recently delivered mothers, mothers with two years old child etc. and local persons who generally use the services at PHCs were contacted to know the overall functioning of PHCs. It was observed that the services in respect of early registration of ANC, 3 Ante Natal checkups, referral transport, awareness of sick new born care and motivation about uses of contraceptive etc. needed improvement in the areas of both the visited PHCs. b. The Medical officers at PHCs Chakpikarong and Tengnoupal were not visiting villages regularly. 9. Sample Verification of F.W. acceptors: a. The team selected a total of 22 acceptors of spacing methods of family planning and out of that 16 (73%) could be contacted for sample verification.