Supportive Supervision Report Dholpur Rajasthan

Submitted by

HUMA SIDDIQUEE

Consultant-NRHM I

MoHFW, New Delhi

[email protected]

1 evolving rajasthan……

TABLE OF CONTENTS

INTRODUCTION…………………………………………………………………………2

MAJOR OBSERVATIONS ………………………..…………………………………….3 . FACILITY WISE ASSESSMENT………………………………………………………..8

RECOMMENDATIONS AND SUGGESTIONS……………………………………….18

ANNEXURE………………………………………………………………………………19

FORM A Draft Yearly Format FORM A RCH Sub plan FORM B Draft Quarterly Format FORM C Facility Operationalization Format FORM D & E Inspection Format for Health Facilities

DHOLPUR

INTRODUCTION

Rajasthan is one of the largest and poorest states of India, with many of its health care indicators below the national average. Public investment in health has declined to 0.9 percent of the gross domestic product (GDP). The gap has been filled by the private sector, which is contributing more than 80 percent of the total health care costs in the state. Health insurance coverage is estimated at 12 percent of the national population (state data not available) and is limited to a few groups that include employees of the government and large private-sector firms.

Delivery of health care has been decentralized to the state level, and a further attempt is being made to decentralize it to the district level. The district officers are responsible for all the health care facilities in the district, which include community health centers (CHCs), primary health centers (PHCs), and sub centers. However, there are significant gaps in the delivery of health care services, especially in rural areas. Gaps range from lack of medical and paramedical personnel (more than 25 percent in some areas) and poorly maintained facilities to lack of basic medical supplies and essential drugs.

An issue constantly articulated with respect to poor health care services in Dholpur is vacant posts of doctors in the district. Staff adequacy on paper does not translate into functional staff availability in this area; it is not uncommon to find that some staff members are away from the place of work on account of leave or another reason. Places like Bari and Baseri are not an attractive posting, and staff invariably seeks a transfer for a number of reasons. Non availability of specialists is another problem because of which only one CHC is functional out of six, rest of them are providing services like a PHC.

People go to Dholpur for Institutional deliveries because of sub-standard health delivery in rural areas – both with respect to health infrastructure and the manpower.

MAJOR OBSERVATIONS

1. JSY beneficiaries have been issued account payee checks for some time now in Rajasthan. There are a lot of problems being faced by people in getting their accounts being opened in banks. Hence many of them are being devoid of the benefits they are entitled to.

Following is the newspaper article being published on the same day of the visit. It states about the problems being faced by the local people because of these changes.

2. There is huge level of disappointment and low motivation level among PHC ASHA Supervisors being appointed at PHCs to monitor ASHAs in their area. Most of them are not satisfied neither motivated to do their jobs effectively. The problem seems to be in the selection procedure of these supervisors which needs consideration because the people selected are mostly over qualified and hence dissatisfied with the job.

3. The private sector in India has over 20,000 manufacturers producing more than 70,000 drug formulations, which are shipped through more than 12,000 distributors and retailers in Rajasthan. The National Drugs Policy has been responsible for the prolific growth of the private sector, albeit with significant concerns for quality, irrational drug use, and inappropriate sales and marketing activities.

The state does not have sufficient human and financial resources to monitor the trade in pharmaceuticals.

In general, drugs are widely available, but essential generic drugs are neither widely available in pharmacies nor frequently prescribed—physicians and pharmacists promote the use of branded drugs.

4. Visits to the Primary Health Centres indicated an increase in the number of deliveries, particularly after the implementation of Janani Suraksha Yojna (JSY) in September 2006.

5. The sub centre being the first point of contact between the community and the public health system has a critical role to play in image building and service provision. Sub centres needs to be strengthened in terms of infrastructure, supplies and human resource.

6. There are high rates of absences and these are not just due to staff outreach activities. Since sub centres are often staffed by only one nurse, this high absenteeism means that these facilities are often closed.

7. Given that public facilities are meant to be free, why do they cost about as much as the private facilities? Besides Lab Tests not being provided free the public facilities do not always provide free medicines. Government stipulates that medicine must be supplied for free as long as they are available, but that when the medicine is not available, the medicine needs to be purchased from the market. But it is often observed people paying for medicine purchased inside the facility also.

8. Not many health personnel are willing to stay in the rural health centres for institutional deliveries. There is a norm of keeping them for at least 48 hours as

7 inpatients for the mother to get JSY benefit but sub centres are not strengthened in terms of infrastructure and also manpower to support 48 hrs stay. Hence people do not prefer to go to sub centre for deliveries.

9. Janani Suraksha Yojna:

 While interacting with the beneficiaries of JSY some of the villagers even said that they would prefer having more babies for the amount they are receiving under JSY scheme and said they would not go for sterilization as it has less amount as incentive.Following is the statement of one of the villagers:

“Madam baccha band karvane ke 600 milte hain aur bacche karne ke baad 1700, hum kyun bacche band karvane ka peration karvaye”

 There is lack of specialists e.g. Gynaecologist/Anaesthetist/Paediatrician and paramedical staff for the implementation of the programme, leading to increased workload and poor management especially for complications.

 There is either absence or lack of institutional logistics. There is no labour room as well as equipments at the Model Sub centres to conduct deliveries while the most of the ANMs are skilled and SBA trained.

 There is shortage of antibiotics, non-availability of oxytocins, methergin, misoprostol, at institutional level.

 It was also found that there was delay in disbursement of funds to the accreditated private hospitals at some places.

 There was non-availability of transport facilities for referral cases at BEmOC level and Model Sub-centres where the attendants of patients hire the private vehicles for the purpose of transporting the patients in emergencies by their own efforts.

 All ANMs who had undergone training in Skilled Birth Attendance (SBA) had heard of the term partograph and knew its use. However, at no level of health facility a partograph was being used.

 It is being observed while interacting with local people that they have more faith in Dais whether trained or untrained than ASHAs.The traditional Dais could be trained and designated as ASHA.

 There is often a concern of the institutional Staff that ASHAs do not come with patients on time. Especially in night deliveries, they do not accompany the patient and turn up the next day and insist that her name be added as having accompanied the mother.

Status of examination table at a sub centre

10. Antenatal Care

All sub centres had BP instrument, stethoscope, weighing machine and hemoglobinometer but some of these were unused.Hemoglobin estimation is not being done at most of the sub-centres. The reason given by ANMs for not doing Hb estimation was that they did not have N/10 HCl. Some of them even said that they had not been trained in estimation of blood Hb.

11. Infrastructure Gaps

As per data provided, every block in the district is short of PHC. The gap varies between one in Dholpur, Bari and Rajakhera and two in Baseri as per WHO norms. On the other hand it has more sub-centres than the required number. Basedi CHC has 28 Sub Center in its jurisdiction; it is difficult to manage the programmes. In this block three new PHCs i.e. Nadanpur, Jarga, and Boroli is recommended. These extra subcentres are very poor in terms of infrastructure and other facilities. Such sub centres should rather be upgraded to PHC to cover the shortfall of PHCs in the area.

FACILITY WISE ASSESSMENT

District Hospital

The important issues considering the district hospital of Dholpur are: The hospital building is in very scattered form. The main building of the hospital where emergencies and deliveries are catered does not have an OT. The OT is in other part of the building quite a long distance in case of emergency situations.Atleast a minor OT should be located in the same block in vicinity to the labour room to handle C-Section and other complications. While the major OT can be functional as it is. The labour room needs to be upgraded in terms of equipments and CSU to be managed more efficiently.

District hospital scored 80 out of 120 based on the facility assessment format.

35 30 25 20 15 10 5 max marks 0 score

CHC-Bari Bari CHC scored excellent in facility assessment. The CHC should be encouraged to apply for ISO certification.

35 30 25 20 15 10 5 max marks 0 score

CHC-SAIPAU

Construction work is going on. Because of increased JSY load another maternal ward is being constructed. The scarcity of water and electricity supply is common among almost all the facilities in these districts.

35 30 25 20 15 10 5 max marks 0 score

Comparison of facility scores of the two CHCs visited-

FACILITY SCORE

120 100 80 60 FACILITY SCORE 40 20 0 BARI SAIPAU

PHC-PACHGAON

Construction work is going on because of which normal working of PHC is being hampered from last few months.

35 30 25 20 15 10 5 max marks 0 score

PHC-KACHANPURA

The PHC did not score well in infrastructure and equipments and supplies but the BMW management was good.

35 30 25 20 15 10 5 max marks 0 score

PHC-SARANIKHERA

The PHC building was well maintained and clean.

35 30 25 20 15 10 5 max marks 0 score

PHC-TASIMO

Lab not working properly. Only malaria testing is being done. Other basic tests are also not being performed here.

Deliveries conducted are also very less. Last year only 15 deliveries conducted in this PHC.

In Mukhya Mantri BPL Jeevan Raksha Kosh scheme no medicines were available.

35 30 25 20 15 10 5 max marks 0 score

Comparison of facility scores of the four PHCs visited-

FACILITY SCORE

60 50 40 30 20 10 FACILITY SCORE 0

SC-JAPAWALI

70 60 50 40 30 20 max marks 10 0 score

SC-BORELI

70 60 50 40 30 20 10 max marks 0 score

SC-KARIMPUR

The sub centre is very well built and very spacious but it is not functional. Electricity and water is not available.

70 60 50 40 30 20 max marks 10 0 score

Comparison of facility scores of the three sub centres visited-

FACILITY SCORE

70 60 50 40 FACILITY SCORE 30 20 10 0 BORELI JAPAWALI KARIMPUR

Visited ASHA TRAINING centre in Dholpur

The objective of the ASHA training program is to train ASHAs with basic knowledge in healthcare and medicine using custom designed methods and materials over four modules: basic health and hygiene; maternal and child health; HIV/AIDS, communicable diseases; and advocacy. The Second round training of 10 days was being conducted in the Dholpur district.

Except for some logistic arrangements at the place of training, ASHAs appreciated the training including trainers and training methods as good and useful.

Most of the ASHAs appreciated arrangements at the training site and nine out of 10 reported that sitting arrangement, accommodation, food, and size of the room were good and had no suggestions to offer. Only a few (3 percent or less each) suggested for proper arrangements of beds/bed sheets, access to latrine/bathroom, more space in the training room, need to tackle the water problem, and for proper food arrangements. A few ASHAs mentioned TV, electricity, and fan during training. Good logistic arrangements during training contributed to enhancing learning. Majority of ASHAs found the training to be participatory and said that the trainers encouraged them to ask questions and answered their queries properly. The trainers used charts/ models to explain the topics.

Comparison of various facilities visited in the district in terms of their percentage scores

90 80 70 60 50 40 30 20 % MARKS SCORED 10 0

Bari CHC scored above 80% while Saipau CHC, Pachgaon PHC, Tasimo PHC and Japawali SC scored marks below 50%

RECOMMENDATIONS AND SEGGESTIONS

There should be tie up with some banks to open zero balance account for the JSY beneficiaries. As well as some of them already have their accounts under NREGA scheme. These accounts can also be utilised for their payment under JSY.

There should be performance appraisal system for ASHAs. Good performing ASHAs should be promoted as PHC ASHA supervisors. This would be an excellent motivation factor for ASHAs and would pave a clear career path and vision for them.

The potential intervention to improve availability and access to generic drugs could be to improve access to medicines at the primary health centres. Broadly speaking, to develop a network of rural-based retail pharmacy outlets to sell high-quality, low-cost generic drugs. The outlets would be situated in or near primary health centres and would coordinate their activities with the operations of the PHCs.

The Primary Health Centres need to be strengthened in terms of skilled human power, infra structure, drugs, equipments and supplies. So that the load on higher level institutions could be reduced considerably.

While the skill building and investing in human resource is important, there is also a need to equip the providers with the necessary and basic facilities to be able to perform their services optimally. Training of ANMs for SBA must be accompanied by site preparedness and community partnership to achieve the goal of MMR less than 100/1000 live births by the year 2012.

IEC activities must be strengthened to generate awareness among the non- beneficiaries regarding the benefits of Institutional deliveries which should not just be concentrated on monetary benefits. There is a need for repeated training and sensitization of MOs, ANMs, LHVs and ASHA about the benefits of the programme.

Basedi CHC has 28 Sub Center in its jurisdiction; it is difficult to manage the programmes. In this block three new PHCs i.e. Nadanpur, Jarga, and Boroli is recommended.

Bari CHC is performing excellent.It is recommended to apply for ISO certification.

ANMs to be sensitised for providing proper ante natal care.ANMs are still not being able to manage and detect anemia cases at early stages which leads to complications.ANMs are to be trained to use the hemoglobinometers which are just lying in sub centres unused.

ANNEXURE

Form A: Supportive Supervision Form

Yearly Monitoring Format

Name of Consultant: Huma Siddiquee

Name of the District and State: Dholpur (Rajasthan)

Date: 17 June 2010

Infrastructure:

DH CHCs BPHCs PHCs APHCs/ HSC NPHC’s Blocks Population 1.Dholpur 1 2 0 9 - 67 2.Bari 0 1 0 3 - 48 3.Basedi 0 2 0 3 - 40 4.Rajakheda 0 1 0 6 - 44 5. 6. 7. Total (In Position) 1 6 0 21 - 199 Total Functional 1 6 21 199 Total Functional (providing 1 6 0 8 - 6 delivery services) Target for 1 0 0 0 - 0 New Constructions (2010-11) Target for 0 0 0 5 - 20 Operationlization Number of new constructions 0 0 0 2 0 10 (PHC, CHC etc) initiated before April 2008 and not yet Completed. Number of major civil works 0 0 0 3 0 0 initiated (construction of labour rooms, wards etc. In existing premises) before April 2009 and not yet Completed.

Facility 2009-10 In position Target 2010-2011

SNCU FBNC is Functional 0 Stabilization Unit (CHC/BPHC) 0 1

Human resources available in the district State:-Rajasthan As on month_June_2010 District:-Dholpur Category Regular Contractual Total Requir Shortf Targe Sanc In Sancti In avail ed for all t tione positi oned positi able the 2010- d on post on existin 11 post (avail (avail g able able faciliti es* Mid wives ANM 247 247 125 88 335 37 37 - LHV 30 27 - - 27 3 3 - PHN 4 4 5 4 4 1 1 1 Nurse 81 81 158 142 223 16 16 16 Total 362 359 288 234 589 20 20 17 Other technical Health workers 35 17 - - 17 - - - [male] Lab technician 30 27 5 4 31 0 1 1 Pharmacist 3 3 7 5 8 2 2 - Radiographer 6 6 2 2 8 0 0 0 Total 74 53 14 11 64 2 3 1 Medical MO/GDMO 76 49 0 0 49 27 27 - Specialist Obstetrics 6 2 3 0 2 3 3 3 “ paediatrics 5 1 3 1 1 3 3 3 “ anaesthesia 2 2 3 0 0 4 0 3 Surgery 8 3 0 0 3 5 5 - Medicine 8 3 0 0 3 5 5 - Ophthalmology 4 2 0 0 2 5 5 - Total 109 62 9 1 60 52 48 9 *Also analyse requirements as per services provided by the facilities qualitatively

H.R performance Data (District level) No. Of OPD cases per doctor in the district - No of Obstetricians performing C.Sections out of Total available 5 Number of C-sections performed per obstetrician at Level 3 facility 357 No of Ophthalmologists performing Cataract Surgeries out of Total available 2 Number of cataract surgeries performed per ophthalmologist 1108 No. of LSAS trained personnel providing services 0 No. of EmOC trained personnel providing services 0 Percentage of deliveries performed by SBA trained personnel’s 6.86 {[( deliveries performed by SBA trained personals / total number of

23 deliveries]*100} Number of deliveries performed per SBA 26.3 Average number of outpatient cases seen by the mobile medical unit (MMU) 17590

Training Activity / Measurable indicator 2009-10 Target 2010-2011 Percentage of ANMs trained as SBAs 21.14 Total 36 Number (SBA trained ANMs/Total Number of in Two batches ANM*100) Percentage of nurses trained as SBAs - (SBA trained nurses/Total Number of nurses *100) Number of Doctors trained on EmOC 2 Number of Doctors trained on LSAS 0 - Number of Doctors trained in NSV/ 0 - Conventional vasectomy Number of Doctors trained in Abdominal 0 - Tubectomy (Minilap) Number of Doctors trained in Laparoscopic 0 - Tubectomy Number of Personnel trained in FIMNCI 576 48 Number of ASHAs completed four modules of 0 694 training

Financial Indicators Percent expenditure of funds through Non Governmental Organization (NGO) 1.83 Number of facilities with less than 50% utilization of the untied grants (BPHC 6 and above) Percentage of JSY payments pending as on 31 March 2010 (with regards to 12% institutional deliveries in the public facilities only)

Indicators Activity / Measurable indicator 2009-10 Target 2010- 2011 Deliveries 1. Total expected 32325 32325 2. Total Reported 26815 30500 a. Institutional 23704 27000 b. Home SBA 53 NA c. Home Non SBA 86 NA 3. Total Unreported (1-2) 5510 NA 4. Percentage of Institutional Deliveries 73.83 90 {[(Institutional/total expected)]*100} 5. Percentage of C- sections performed (w.r.t 1.50 - institutional deliveries): {[(no. of C section performed/ institutional deliveries)]*100)}

6. Percentage of C- sections performed (w.r.t. 1.10 - expected deliveries: {[(no. of C section performed / expected deliveries)]*100)} 7. Percentage of maternal complication (medical 2.37 - and surgical)treated against total institutional deliveries {[( maternal complication treated / institutional deliveries)]*100)} 8. Percentage of maternal complication (medical 1.7 - and surgical) treated (w.r.t. expected deliveries): {[(no. of maternal complication treated / expected deliveries)]*100)} 9. High risk pregnancies identified {[(no. of high NA - risk pregnancies identified / No. Of ANC registered)]*100)} Percentage of pregnant women tracked 40407 40407 Percentage of fully immunized children 87.50 95% Family Planning 1. Male sterilisation (in numbers) 40 810 2. Female Sterilization 4741 7352 3. No. of IUD insertion 4975 5594 No. Of Facilities providing safe abortion services* 7 - Disease control Case Detection Rate of TB among new sputum positive 78 Lacks of 56 Lacks patients popu.(140% of target) Treatment Success Rate among new sputum positive 87% >85% patients initiated on DOTS ABER for Malaria 11.8 - API for Malaria 2 - No. of Reconstructive surgeries performed under NLEP 0 Annual New Case Detection Rate for Leprosy 90% 100% *Explore qualitatively the methods of safe abortion used

Service Delivery Percentage of Medical camps conducted against planned {[medical camps - conducted/medical camps planned]*100} Percent of VHNDs conducted against planned 91%

Number of functional Mobile Medical Units (MMU)1 1

Other Indicators Is community based monitoring system existent in the district? (Yes / no ) No Percent of data elements uploaded in last quarter of 2009-10 60 Percentage of functional/ working ILR points2 46.42

1 Analyze as per state policy

{[number of functional ILR points]/ [number of total ILR points]}*100 Qualitative explore plan for inaccessible areas [in details] -

FORM A: RCH SUB PLAN

SUB PLAN FOR DISTRICT- DHOLPUR

A. Total Population : 1196300 CBR : 27.5 B. Expected Deliveries per year : : 32898 ( calculated from above) C. Total reported deliveries ( from HMIS) : 25670 in nos and as 78.02 % of expected deliveries : D. Actual Delivery ( from HMIS verified at dt & block) as numbers and as % of expected deliveries: 74.58 (Ins) + (home): Home SBA 3.04 Home Non SBA2.23

Deliveries Facility operationalisation 2009-10 2010-11 2011-12 2009-10 2010-11 20 11- 12 Level 1 facility Total nos. Of 1886 2055 2671 30 44 54 deliveries Normal 1886 2055 2671 - - - - - Total- Total- Tot - al- Level 2 facility Total no. of 9638 11565 13878 7 13 18 deliveries Normal 9635 11333 13602 Others complicated 3 232 276 Total- Total- Tot al- Level 3 facility Total nos. of 13401 14741 14741 2 4 5 deliveries Normal 13111 14448 1448 C-sections 290 293 293 Other complicated / 461 600 600 Total- 39 Total- 61 Tot expected al- complications 77

HR Planning

2 ILR : Ice Line Refrigerator

Current Target Existing Additional Training load Supportive Budget level HR HR supervision required Level 1 facility (PHCs and 280 - - - - SCs) 220 - - Level 2 facility - - 12 15 96 - - Total- Total- Level -3 facility - - 2 5 389 - - Total- Total-

Infras-tructure Planning-

Existin Addition Provision for Newborn Infrastructur Ref g beds al beds Blood banks / Corners/ e & erra to be Blood Storage Neonatal Equipment l added Units Stabilisation required tran Units/ SNCUs spo needed rt Level 1 facility 63 15 0 0 As per Norms Nee ded Level 2 facility 198 25 0 8 As per Norms Nee ded Level 3 facility 375 0 5 1 As per Norms Ava ilabl e

Current Level Aims to Reach Home Based Newborn and Sick Child Care 30% 100% ANM Skills in Child care 40% 100% Line Listing of Pregnant Women and Children below 70% 100% 2 Facilitation for ASHA’s/ Mothers at Facility 40% 100% NGO Involvement 2% Depend upon state Other activities (pls specify)

Additional Fund Requirement (Proposals not included in state PIP 2010-11) Activity Rate & No. Fund Required

USG Machine At CHC badi 1 5.00 Lakh Bcmo Office cum Drug warehouse At Badi 3 100.00 Lakh ,Basedi,& Rajakhera Ambulance For CHC Bari 1 2.40 lakh OPD wing At Bari 1 20.00 Lakh

Total 127.40

Form B: Supportive Supervision Form

Quarterly Monitoring Format

Name of Consultant: Huma Siddiquee

Name of the District and State: Dholpur Rajasthan

* For all the below indicators cumulative figures from the month of the consultant’s last visit upto the month previous to the current visit have to be recorded unless otherwise specified.

Infrastructure DH CHCs BPHCs PHCs APHCs/ HSC NPHCs New constructions 1 0 0 0 - 1 initiated Major Civil Works 0 0 0 0 0 0

1.Initiated 0 0 0 0 0 0

2.competed 0 0 0 0 0 0

Facility Target Q I Q II Q III Q IV 2010-2011 SNCU 2 - Stabilization Unit (CHC/BPHC) - Functional Mobile Medical Units (MMU)3 1 1

Human resources: New Recruitments in the district State:Rajastahan As on month___June___2010 District:Dholpur Category Target 2010- New New

3 Analyze as per DHAP- Note;-Recruitment is state level

11 recruitment recruitment [regular] [contractual] Mid wives - ANM 80 0 52 LHV - - - PHN - - Nurse - - - Total - - - Health workers [male] - - - Lab technician - - - Pharmacist - - - Radiographer - - - Total - - - MO/GDMO - - - Specialist Obstetrics 3 0 - “ paediatrics 3 0 - “ anaesthesia 3 0 - Surgery - - - Medicine - - -- Ophthalmology - - - Total - - --

H.R performance Data (District level) Indicator Last Cumulative from Quarter( April 2010 till Apr- previous month of June10) the visit No. Of OPD cases per doctor in the district - No of Obstetricians performing C.Sections out of Total 1 available Number of C-sections performed per obstetrician at Level 3 1 facility No of Ophthalmologists performing Cataract Surgeries out of 81 Total available Number of cataract surgeries performed per ophthalmologist 40.5 Percentage of deliveries performed by SBA trained 4.07 personnel’s {[( deliveries performed by SBA trained personals / total number of deliveries]*100} Number of deliveries performed per SBA 5.72 No. of LSAS trained personnel providing services 0 No. of Emoc trained personnel providing services 2 Average number of outpatient cases seen by the mobile 366 medical unit (MMU)

Training in the respective visits (New trainings conducted in the Quarter till the date of the visit)

Activity / Measurable Target 2010- Visit in Visit in Visit in Visit in 2011 Q I Q II Q III Q IV indicator Number of ANMs trained as 36 0 SBAs Percentage of ANMs trained 28.8 as SBAs(SBA trained ANMs/Total Number of ANM*100) Number of Doctors trained on 8 0 EmoC Number of Doctors trained on 0 LSAS Number of Doctors trained in 0 NSV/ Conventional vasectomy Number of Doctors trained in 0 Abdominal Tubectomy (Minilap) Number of Doctors trained in 0 Laproscopic Tubectomy Number of Personnel trained 48 0 in IMNCI Number of ASHAs 693 0 completed four modules of training

Financial Indicators Number of facilities with less than 50% utilization of the untied grants (BPHC 220 and above) Percentage of JSY payments pending as on day of visit (with regards to 8% institutional deliveries in the public facilities only)

Indicators* Activity / Measurable indicator Target 2010- Achievement Achievement 2011 from April from April 2010 till 2010 till Month Month previous to previous to the Month of the Month Visit (in of Visit (in numbers) %) (Apr-June10) Deliveries 10. Total Reported 32325 5640 d. Institutional 32325 5125 e. Home SBA NA 230

f. Home Non SBA NA 285 11. Percentage of C- sections performed NA .01 (w.r.t institutional deliveries): {[(no. of C section performed/ institutional deliveries)]*100)} 12. Percentage of C- sections performed .02 (w.r.t. expected deliveries: {[(no. of C section performed / expected deliveries)]*100)} 13. Percentage of maternal complication NA 0.93 (medical and surgical)treated against total institutional deliveries {[( maternal complication treated / institutional deliveries)]*100)} 14. Percentage of maternal complication 0.59 (medical and surgical) treated (w.r.t. expected deliveries): {[(no. of maternal complication treated / expected deliveries)]*100)} 15. High risk pregnancies identified NA {[(no. of high risk pregnancies identified / No. Of ANC registered)]*100)} Family Planning 1. Male sterilisation (in numbers) 0 2. Female Sterilization 50 3. No. of IUD insertion 2510 No. Of Facilities providing safe abortion 7 services Service Delivery (For previous month)

Disease control Case Detection Rate of TB among new 38.38 sputum positive patients Treatment Success Rate among new sputum - positive patients initiated on DOTS ABER for Malaria - API for Malaria - Annual New Case Detection Rate for 2 New Case Leprosy Target 20 for Whole year Cataract Surgeries performed in the District 632 No. of Reconstructive surgeries performed 0 under NLEP

Percentage of Medical camps conducted against planned {[medical camps 85.18% in Apr conducted/medical camps planned]*100} –june10 Percent of VHNDs conducted against planned* 96.02% in Apr –june10 Functional Mobile Medical Units (MMU)4 1

*In last 3 months according to the VHND microplan (check the Sub Centre Register)

Other Indicators (previous month data) Percent of data elements uploaded 59 Percentage of functional/ working ILR points5 46.42

4 Analyze as per state policy 5 ILR : ice line refrigerat

Form C: Supportive Supervision Format for Proposed Operationlization of the Facilities in the District Sub Plan 2010

The consultant shall list out all the facilities proposed for Operationlization in the district sub plan for 2010-11. During visits, it is expected to take feedback on the progress of the Operationlization in the following format by ticking in front of the each expected service.

Sub Centre

Names Infrastructur Electricity Essential Stay facility Equipments for Conducting New Born Commen e and water Drugs for the conducting deliveries Baby t ANM delivery and Corner newborn resuscitation

BLOCK BARI Dhimari Yes No Yes No No No NO

Nidhara Yes No Yes No No No NO

Kasoti khera Yes No Yes No No No NO

Chila chond Yes No Yes No No No NO

Richari Yes No Yes No No No NO

Sikrra Yes No Yes No No No NO

Umreh Yes No Yes No No No NO

Naksoda Yes No Yes No No No NO

Sahedi Yes No Yes No No No NO

Sanora Yes No Yes No No No NO

sunni pur Yes No Yes No No No NO

Ibhrahim pur Yes No Yes No No No NO

Ghari sukkha No No Yes No Yes No NO

Badharetha No No Yes NO Yes NO

Sikrondha Yes No Yes NO NO

Mahuaa khera No NO Yes No Yes NO

Rupaspur No Yes Yes NO

Totari Yes NO

Dhanora Yes NO

Singori Yes NO

Alighara Yes NO

Madha gurjar No Yes Yes NO

Kuhawani NO NO NO NO NO NO NO

Kareruaa NO NO NO NO NO NO NO

Rahal NO NO NO NO NO NO NO

Nohara NO NO NO NO NO NO NO

Soha NO NO NO NO NO NO NO

Ranpur NO NO NO NO NO NO NO

Jamalpur NO NO NO NO NO NO NO

Marholi Yes NO

Surothi Yes NO

Naghala dhula Yes NO kha

Japawali Yes NO

Pidawali Yes NO

Mathasura Yes NO

Rajai khurd Yes NO

Baripura Yes NO

Basai dang Yes NO

Sever pali Yes NO

Sone ka gurja Yes NO

Gajpura Yes NO

Rundhara Yes NO

Bijoli Yes NO

Kuddinan Yes NO

kuaakhera NO NO NO NO NO NO NO

Khanpur Yes NO Gurjar

Chandelpura NO NO NO NO NO NO NO

Nayapura NO NO NO NO NO NO NO

BLOCK Rajakhera Bajana Yes NO

Devkhera Yes Yes Yes NO

Didwar Yes Yes Yes NO

Singhawali Yes NO kalan

Khudila Yes NO

Sikronda Yes NO

Dongarpur Yes NO

Khanpura Yes NO

Singhawali Yes NO

Jatoli Yes NO

Luhari Yes NO

Tagawali Yes NO

Bhesena Yes NO

Bhamroli Yes NO

Gadarai Yes Yes Yes NO

Changora Yes Yes Yes NO

Samor Yes NO

Sundarpur Yes NO

Kasimpur Yes NO

Lalpur Yes Yes Yes NO

Basai Yes NO Ghiyaram

Ghadi Yes NO Kareelpur

Silawat Yes NO

Jarah Yes Yes Yes NO

Ghadi Jafar Yes Yes Yes NO

Machhariya Yes NO

Basai Kare Yes Yes Yes NO

Aam ka pura Yes NO

Nadoli Yes NO

Kherli Yes NO

Mangrol Yes NO

Karka Kherli Yes NO

Sahajpur Yes NO

Andwa pureni Yes NO

Dulhara Yes NO

Ghadi Yes NO Vintipura

Tor Shankara Yes Yes Yes NO

Shahapura Yes NO

Vichola Yes NO

Jalalpur Yes NO

Nagar Yes Yes Yes NO

Parasuapura Yes Yes Yes NO

Ganhedi Yes NO

Ajitapura Yes NO

BLOCK DHOLPUR Sakhwara Yes NO

Nidherakala Yes NO

Nidherakhurd Yes NO

Bhadiyana Yes NO

Kurendha Yes NO

Kharagpur Yes Yes Yes NO

Musal pur NO NO NO NO NO NO NO

Tekuli NO NO NO NO NO NO NO

Indoli NO NO NO NO NO NO NO

Kumheri Yes NO

Nunhera Yes NO

Dubepura Yes NO

Kanasil Yes NO

Kukra Yes NO

Kaithari Yes NO

Semara Yes NO

Rajorakhurd Yes NO

Kankoli Yes NO

Dungarwala NO NO NO NO NO NO NO

Gadhilazza Yes Yes NO

Vishnoda Yes NO

Puranichawani Yes NO

Kotra Yes NO

Barkheda Yes NO

Sahron NO NO NO NO NO NO NO

Sandra NO NO NO NO NO NO NO

Soorajpura NO NO NO NO NO NO NO

Masoodpur NO NO NO NO NO NO NO

Samiti Nibhi Yes NO

Manpur Yes NO

Tehari Yes NO

Bahrawati NO NO NO NO NO NO NO

Raipur Yes NO

Kolari Yes NO

Sarkana Yes NO

Naurangabad Yes NO

Malonikhurd Yes NO

Kolua Yes NO

Aidalpur NO NO NO NO NO NO NO

Bisaytipura Yes Yes Yes NO

Kareempur Yes NO

Umrara Yes Yes Yes NO

Basaisamanta Yes Yes Yes NO

Bageerathpura NO NO NO NO NO NO NO

Kamre ka Pura Yes NO

Bheekapura NO NO NO NO NO NO NO

Basaineem NO NO NO NO NO NO NO

Bichia Yes NO

Badapura Yes NO

Tanda Yes Yes Yes NO

Dayeri Yes Yes Yes NO

Choki Hinota Yes Yes Yes NO

Bothpura Yes NO

Baretha Yes NO

Dandoli Yes NO

Odi NO NO NO NO NO NO NO

Tor daniyal NO NO NO NO NO NO NO

Dubati Yes NO

Dubra Yes NO

Firozpur Yes NO

Piphera Yes NO

Rajorakala Yes NO

Bala ka Nagla NO NO NO NO NO NO NO

Nagla Harlal NO NO NO NO NO NO NO

Donari Yes NO

Piproa Yes NO

Malonipanwar Yes Yes Yes NO

BLOCK BASERI Bada Gaon Yes NO

Bagthar Yes Yes Yes NO

Bansrai Yes Yes Yes NO

Bijholi Yes Yes Yes NO

Chandravali Yes NO

Domai Yes NO

Ekta Yes Yes Yes NO

Gumapur Yes NO

Jarga Yes NO

Kharoli Yes NO

Konesa Yes Yes NO

Kurgava Yes Yes Yes Yes NO

Madasil Yes NO

Mai Yes NO

Mathara Yes NO

Nadanpur Yes NO

Rahrai Yes Yes Yes NO

Reviapura Yes NO

Salempur Yes NO

Tajpura Yes NO

Badaria Yes NO

Banora Yes Yes Yes NO

Bharli Yes NO

Boreli Yes Yes NO

Dhorar Yes NO

Dopura Yes NO

Golari Yes Yes Yes NO

Harjupura Yes NO

Kharagpura Yes NO

Khidora Yes NO

KunKuta Yes NO

Madanpur Yes NO

Mahu Gulavli Yes Yes Yes NO

Mamodhan Yes Yes NO

Mirjapur Yes NO

Pipron Yes Yes Yes NO

Ratanpur Yes Yes Yes NO

Rijhoni Yes Yes NO

Siholi Yes Yes Yes NO

Timasiya Yes Yes Yes NO

PHC, BPHC and CHC

Names Infrastruc Beds in 24X7 SBA Essential Stay facility Cond Stabili Comm ture hospita available Drugs and for the uctin zation ent l Equipment doctor and g Unit BPHC: s staff deliv 6 eries CHC: 30 1.Basai Available 6 Yes Yes Yes Yes No Nawab PHC 2. Saipau Available 30 Yes Yes Yes Yes No CHC 3.Chitora Available 6 No Yes No Yes NO PHC 4.Badrika Available 6 No Yes No Yes NO PHC 5.Viparpur Available 6 No Yes Yes Yes No PHC 6.Maniya Available 30 Yes Yes No Yes No CHC (Not sufficient) 7.Virondha Constructi 6 No Yes No No No PHC on going on 8.Pachgaon Constructi 6 Yes Yes No Yes No PHC on going on 9.Saranikher Available 6 Yes Yes Yes (Only Yes No a PHC for MO)

{[number of functional ILR points]/ [number of total ILR points]}*100

10.Tasimao Available 6 No Yes No Yes No PHC 11.Moroli Not 2 No No No NO No PHC Available 12.Rajakher Available 30 Yes Yes Yes Yes No a CHC 13.Hathwari Available 6 No Yes No Yes NO PHC 14.Marina Available 6 Yes Yes No Yes No PHC 15.Gopalpur Available 6 No No No Yes NO a PHC 16.Jasupura Available 6 Yes Yes No Yes NO PHC 17.Bareh Available 6 No Yes No No No PHC 18.Samona Constructi 0 NO No No NO NO on going on 19.Badi CHC Available 75 Yes Yes Yes Yes No 20.Kanchan Available 6 Yes Yes Yes Yes No pur PHC 21.Abdulpur Available 6 No Yes Yes Yes NO PHC 22.Khanpur Available 6 No Yes Yes Yes NO PHC 23.Basedi Available 30 Yes Yes Yes YES NO PHC 24.Aangai Available 6 Yes Yes Yes Yes NO PHC 25.Baroli Available 6 Yes YeS No Yes NO PHC 26.Sarmath Available 30 Yes Yes Yes Yes NO ura CHC 27.Jhiri PHC Available 6 No No Yes NO NO

Level III institutions

Names of the 24X7 C Blood Bank 24X7 Specialist SNCU Comment facilities section availability facility 1.General Hospital Yes Yes Yes FBNC Dholpur functional 2. CHC Badi Yes BSU functional Yes No

Form D: Inspection format for health facilities

Name of the Consultant: Huma Siddiquee

District:Dhaulpur Total marks: 125

Name of Facility (APHC/BPHC /Referral/ SD/Sadar): District Hospital

1. No. of Doctors (with details of specialists available): 17(surgeon,ENT,ortho,gynae,skin,anesthetist) 2. No. of Nurses: Posted:60 Deputed: 3. No. of ANM’s: Posted: Deputed: 4. No. of SBA trained Personnel: 5. No. of Beds: Sanctioned: Functional: MCH beds:

I. Infrastructure

Item MOV Criteria Score Building a. Walls and floor and roof intact 1 condition b. Electrical wires not exposed 1 c. Electric switch boards not broken 1 d. Electric bulbs in wards / pathways / toilets 1 e. Whitewashed 0 f. Signage boards present 1 g. Rooms not dumped with condemned articles 1 Total=6 Condition of a. Mosquito screens present and devoid of holes 0 wards b. Condemned articles not stored in the wards 1 c. window glasses not broken 0 d. Door / Screens / Curtains / present for ensuring privacy of 0 patient 1 e. Availability of ceiling fans in wards Total=2

Water supply a. Running water available for 24 hours in Labour room 2 b. Running water available for 24 hours in OT c. Running water available for 24 hours in Toilets 2 d. Purified drinking water available for drinking for patients in 2 OP 0 e. Purified drinking water available for drinking for patients in IP 0 Total=6 Condition of a. Doors are not damaged 1 b. Floors are clean

42 toilets c. Basins are not stained 1 d. water taps not damaged, 0 e. pathway is not dirty 0 f. Separate for male and female 1 1 Total=4 Patient a. Seating arrangements are present in the OPD area 1 amenities b. Stools or chairs for attendants in the wards present 0 c. Inpatients are provided with blankets in winter 0 Total=1 Furniture a. Cots are not rusted, not broken 1 b. Mattress not worn out, cloth not torn, cotton/coir not 0 coming out

Drainage a. Drainage system not clogged 1

II. Human Resource (Self improvement score)

Staff performance Baseline data (1st Subsequent visit survey) *

(monthly figure ) % improvement Number of deliveries conducted per 500/month Number of OP cases 500/day Bed occupancy rate* Number of CS per Obstetrician Number of cataract operations per ophthalmologist Chest symptomatic sputum population examination rate Minor surgeries per doctor Antenatal care severely anaemic (under 7 gm%) managed rate IUD insertions per trained nurse MTP services per trained doctor

o Indicative column; subsequent visits (2nd, 3rd etc. Would be scored on improvement and in a fresh inspection form)

o Bed occupancy rate=(inpatient days of care/bed days available)×100

III. Services available (applicable for BPHCs and above)

Sl.no Service Means of verification Score 1. 24 hour doctor available Duty roster, casuality register 2 2. 24 hour nurse available Duty roster, casuality register 2

3. 24 hour delivery services Delivery register 2 available

4. 24 hour newborn care Delivery register, Paediatric ward register, 2 services available Immunization register 5. 24 hour caesarean services Delivery register (if FRU) 2

6. Tubectomy services FP register 2 available 2 7. Safe abortion services MTP register available 2 8. 24 hour blood transfusion Blood transfusion register / Blood bank master services register 2 9. Laboratory Services Equipments and reagents for conducting the

tests are present, lab record shows tests are

1. Haemogram conducted 2. Sputum Examination

3. Lipid Profile Lab register 4. Hormone Assay 5. Urine Examination 2 10. Availability of ECG Facility ECG machine available & working 2 11. X Ray Facility with X-ray X ray register – working status Technician available 2

12. Ultrasound services available USG register – working status

13. Ambulance Records of operation [Number of ambulances, average (if more than one ambulance) number of breakdowns in the last one week, number of drivers available per shift] maintained 1. Functional telephone Telephone number with dial tone 1 2. Adolescent sexual and OP register – number of adolescent beneficiaries

reproductive health services 3. Whether fixed day antenatal ANC register clinics are conducted

4. Whether fixed day RTI/STI OPD Register

clinics are conducted 5. Whether fixed day Register 1 sterilization clinics are conducted 6. Whether IEC material displayed 1

7 Public Display of JSY

Beneficiaries Total=27

IV. Services Out-Sourced

Sl. Item Means of verification Score no 1. House a. Floor is cleaned with disinfectant on the day of visit 1 keeping b. rainbow linen colour maintained 0 c. OT fumigated 0

2. Generator a. Generator in working condition with designated horse 1 power 1 b. Fuel for operation present 1 3. Food a. Food served to inpatients 0 b. Food chart for inpatients Total=4

V) Equipments and supplies

Item MOV condition Score Trolley a. In working condition 0 b. Trolley without rust

Wheelchair a. In working condition

b. Wheelchair without rust 1

Stretcher a. Stretcher without rust b. not broken 1

Sterilised gloves Sterilised gloves available 1 Average number of OP drugs available (monthly) Drug stock register 3 Availability of life saving drugs present Availability of; 2

a. Oxytocin b. Misoprostol c. Magnesium Sulphate

d. IV antibiotics Total=8

VI. Equipments in Labour room

Equipment MOV Score 1. Spot light in labour room 1 2. Vacuum extractor 0

3. Resuscitation equipment for newborn – Bag and mask 0 4. Resuscitation equipment for newborn – Laryngoscope and full set of 0 endo-tracheal tubes 0 5. Baby resuscitation table with infant warmer 6. Mucous sucker 0 1 7. Baby weighing machine 0 8. Partograph 0 9. Privacy in Labour room (curtains etc)

10. Toilet attached to Labour room 1

11. Protocols displayed: Active management of 3rd stage of labour (also check 0 case sheets)

12. Labour board not rusted, not broken and not blood stained 1 Total=4

VII)Equipments in OT

Equipments MOV score 1. Ceiling OT light/ Floor OT light (shadowless) 1 2. Oxygen cylinder 1 1 3. Boyles apparatus (only FRU)

4. Suction apparatus 1 5. Adequate quantity of linen6 6. Spinal anaesthesia set (FRU) 7. Ante room present Total=4

VIII)Bio-medical Waste Management

Item MOV Score Waste a. Colour coded buckets used 1 management b. Deep burial pit available where anatomical waste is 1 disposed 1 c. Needle cutter in working condition 1 d. no mix of infectious or non-infectious waste done 0 e. waste bins not overfilled 0 f. needles and syringes mutilated and disinfected before

putting in waste bin 1 g. metal sharps disposed in puncture proof containers h. disposable gloves and masks not reused 1 Total=6

IX) Central sterilization unit

MOV Score Autoclave a. Functioning autoclave 1 b. Usage of signalac tape c. usage of biological indicator d. swab test of sterile packs

6 3 sets of linen per surgery per day. (Calculate average number of surgeries per Day )

X) Records and reports

Item MOV score Separate column (in delivery register) for recording major complications leading to maternal death 1 Delivery register mentions about the details of the baby and condition of the 1 mother

Referral slips are issued to patients 1 Total=3

XI) Finance

Head Number of mothers yet to receive the JSY money Score

RKS Full utilization of funds in 2009-10 JSY JSY payments not pending till last week of the visit 2

Appendix 1

Inspection scoring sheet for health facilities

Name of the inspecting officer: Huma Siddiquee Date & time: ......

District:Dhaulpur Total marks: 125

Name of Facility (APHC/BPHC /Referral/ SD/Sadar): District Hospital

Item Maximum Facility marks Score

I. Infrastructure 34 21

II. Human Resource Self improvement score

III. Services available (applicable for BPHCs and 33 27 above)

IV. Services Out-Sourced 7 4

V) Equipments and supplies 10 8 VI)Equipments in Labour room 12 4 VII)Equipments in OT 7 4 VIII) Bio-medical Waste Management 8 6 IX) Central sterilization unit 2 1 X) Records and reports 3 3 XI) Finance 4 2 Total Score 120 80

Form D: Inspection format for health facilities

Name of the Consultant: Huma Siddiquee Date & time : ......

District: Dhaulpur Total marks: 125

Name of Facility (APHC/BPHC /Referral/ SD/Sadar): Bari-CHC

6. No. of Doctors (with details of specialists available): 7. No. of Nurses: Posted: Deputed: 8. No. of ANM’s: Posted: Deputed: 9. No. of SBA trained Personnel: 10. No. of Beds:75 Sanctioned: Functional:75 MCH beds:

II. Infrastructure

Item MOV Criteria Score Building h. Walls and floor and roof intact 1 condition i. Electrical wires not exposed 1 j. Electric switch boards not broken 1

k. Electric bulbs in wards / pathways / toilets 1 l. Whitewashed m. Signage boards present 1 n. Rooms not dumped with condemned articles 1 Total=6 Condition of f. Mosquito screens present and devoid of holes 0 wards g. Condemned articles not stored in the wards 1 h. window glasses not broken 1 i. Door / Screens / Curtains / present for ensuring privacy of 0 patient j. Availability of ceiling fans in wards 1 Total=3 Water supply f. Running water available for 24 hours in Labour room 2 g. Running water available for 24 hours in OT h. Running water available for 24 hours in Toilets 2 i. Purified drinking water available for drinking for patients in 2 OP 2 j. Purified drinking water available for drinking for patients in IP

Total=8 Condition of g. Doors are not damaged 1 toilets h. Floors are clean 1 i. Basins are not stained 1 j. water taps not damaged, 0 k. pathway is not dirty 1 l. Separate for male and female 1 Total=5 Patient d. Seating arrangements are present in the OPD area 1 amenities e. Stools or chairs for attendants in the wards present 1 f. Inpatients are provided with blankets in winter 1 Total=3 Furniture c. Cots are not rusted, not broken 1 d. Mattress not worn out, cloth not torn, cotton/coir not coming out 1 Total=2

Drainage b. Drainage system not clogged 1

III. Human Resource (Self improvement score)

Staff performance Baseline data (1st Subsequent visit

survey) *

(monthly figure ) % improvement Number of deliveries conducted per SBA Number of OP cases 300/day Bed occupancy rate* Number of CS per Obstetrician Number of cataract operations per ophthalmologist Chest symptomatic sputum population examination rate Minor surgeries per doctor Antenatal care severely anaemic (under 7 gm%) managed rate IUD insertions per trained nurse MTP services per trained doctor

o Indicative column; subsequent visits (2nd, 3rd etc. Would be scored on improvement and in a fresh inspection form) o Bed occupancy rate=(inpatient days of care/bed days available)×100

IV. Services available (applicable for BPHCs and above)

Sl.no Service Means of verification Score 1. 24 hour doctor available Duty roster, casuality register 2 2. 24 hour nurse available Duty roster, casuality register 2

3. 24 hour delivery services Delivery register 2 available 4. 24 hour newborn care Delivery register, Paediatric ward register, 2 services available Immunization register

5. 24 hour caesarean services Delivery register (if FRU) 2 6. Tubectomy services FP register available 2 7. Safe abortion services MTP register 2 available 8. 24 hour blood transfusion Blood transfusion register / Blood bank master

services register 2 9. Laboratory Services Equipments and reagents for conducting the 2 tests are present, lab record shows tests are 6. Haemogram conducted 7. Sputum Examination 8. Lipid Profile Lab register 9. Hormone Assay 10. Urine Examination

10. Availability of ECG Facility ECG machine available & working 2 11. X Ray Facility with X-ray X ray register – working status Technician available 2 12. Ultrasound services available USG register – working status

13. Ambulance Records of operation [Number of ambulances, 2 average (if more than one ambulance) number of breakdowns in the last one week, number of Total=24 drivers available per shift] maintained 1. Functional telephone Telephone number with dial tone 1 2. Adolescent sexual and OP register – number of adolescent beneficiaries reproductive health services

3. Whether fixed day antenatal ANC register 1 clinics are conducted 4. Whether fixed day RTI/STI OPD Register 1 clinics are conducted 5. Whether fixed day Register 1 sterilization clinics are conducted

6. Whether IEC material 1 displayed 7 Public Display of JSY Beneficiaries Total=5

V. Services Out-Sourced

Sl. Item Means of verification Score no

1. House d. Floor is cleaned with disinfectant on the day of visit 1 keeping e. rainbow linen colour maintained 0 f. OT fumigated 1

2. Generator c. Generator in working condition with designated horse 1 power d. Fuel for operation present 1 1 3. Food c. Food served to inpatients Total=5 d. Food chart for inpatients

V) Equipments and supplies

Item MOV condition Score Trolley c. In working condition d. Trolley without rust

Wheelchair c. In working condition 1 d. Wheelchair without rust

Stretcher c. Stretcher without rust d. not broken 1

Total=2 Sterilised gloves Sterilised gloves available 1 Average number of OP drugs available (monthly) Drug stock register 4 Availability of life saving drugs present Availability of; 2

e. Oxytocin f. Misoprostol g. Magnesium Sulphate h. IV antibiotics

VII. Equipments in Labour room

Equipment MOV

Score 13. Spot light in labour room 1 14. Vacuum extractor 15. Resuscitation equipment for newborn – Bag and mask 1 1 16. Resuscitation equipment for newborn – Laryngoscope and full set of

endo-tracheal tubes 1 17. Baby resuscitation table with infant warmer 1 18. Mucous sucker 19. Baby weighing machine 1 20. Partograph 1 21. Privacy in Labour room (curtains etc) 1 22. Toilet attached to Labour room

23. Protocols displayed: Active management of 3rd stage of labour (also check case sheets)

24. Labour board not rusted, not broken and not blood stained 1 Total=9

VII)Equipments in OT

Equipments MOV score 8. Ceiling OT light/ Floor OT light (shadowless) 1 9. Oxygen cylinder 1 10. Boyles apparatus (only FRU) 1 11. Suction apparatus 1 7 12. Adequate quantity of linen 1 13. Spinal anaesthesia set (FRU) 1 14. Ante room present Total=6

VIII)Bio-medical Waste Management

7 3 sets of linen per surgery per day. (Calculate average number of surgeries per Day )

Item MOV Score Waste i. Colour coded buckets used 1 management j. Deep burial pit available where anatomical waste is disposed 1 k. Needle cutter in working condition l. no mix of infectious or non-infectious waste done 1 m. waste bins not overfilled n. needles and syringes mutilated and disinfected before 1 putting in waste bin o. metal sharps disposed in puncture proof containers 1 p. disposable gloves and masks not reused 1

Total=8

IX) Central sterilization unit

MOV Score Autoclave e. Functioning autoclave ‘a’ carries 1 mark, f. Usage of signalac tape g. usage of biological indicator b / c / d (either) carries 1 mark h. swab test of sterile packs Total 2 marks

X) Records and reports

Referral slips are issued to patients 1 Total=3

XI) Finance

Head Number of mothers yet to receive the JSY money Score

RKS Full utilization of funds in 2009-10 2 JSY JSY payments not pending till last week of the visit 2 Total=4

Appendix 1

Inspection scoring sheet for health facilities

Name of the inspecting officer: Huma Siddiquee Date & time: ......

District:Dhaulpur Total marks: 125

Name of Facility (APHC/BPHC /Referral/ SD/Sadar):Bari-CHC

Item Maximum Facility marks Score II. Infrastructure 34 28

III. Human Resource Self improvement score

IV. Services available (applicable for BPHCs and 33 29 above)

V. Services Out-Sourced 7 5

V) Equipments and supplies 10 9 VI)Equipments in Labour room 12 9 VII)Equipments in OT 7 6 VIII) Bio-medical Waste Management 8 8

IX) Central sterilization unit 2 0 X) Records and reports 3 3 XI) Finance 4 4 Total Score 120 101

Form D: Inspection format for health facilities

Name of the Consultant: Huma Siddiquee Date & time: ......

District: Dhaulpur Total marks: 125

Name of Facility (APHC/BPHC /Referral/ SD/Sadar): Saipau-CHC

11. No. of Doctors (with details of specialists available):1 MO 12. No. of Nurses: Posted:5 Male Nurse,3 GNM Deputed: 13. No. of ANM’s: Posted: Deputed: 14. No. of SBA trained Personnel: 15. No. of Beds:23 Sanctioned:30 Functional:23 MCH beds:

III. Infrastructure

Item MOV Criteria Score Building o. Walls and floor and roof intact 1 condition p. Electrical wires not exposed 1 q. Electric switch boards not broken 1 r. Electric bulbs in wards / pathways / toilets 1 s. Whitewashed 1 t. Signage boards present 0 u. Rooms not dumped with condemned articles 0 Total=5 Condition of k. Mosquito screens present and devoid of holes 0 wards l. Condemned articles not stored in the wards 0 m. window glasses not broken 1 n. Door / Screens / Curtains / present for ensuring privacy of 0 patient 1 o. Availability of ceiling fans in wards Total=2

Water supply k. Running water available for 24 hours in Labour room 2 l. Running water available for 24 hours in OT

m. Running water available for 24 hours in Toilets 0 n. Purified drinking water available for drinking for patients in 2 OP 2 o. Purified drinking water available for drinking for patients in IP 0 Total=6 Condition of m. Doors are not damaged 1 toilets n. Floors are clean 0 o. Basins are not stained 0 p. water taps not damaged, 0 q. pathway is not dirty 0 r. Separate for male and female 1 Total=2 Patient g. Seating arrangements are present in the OPD area 1 amenities h. Stools or chairs for attendants in the wards present 1 i. Inpatients are provided with blankets in winter 0 Total=2 Furniture e. Cots are not rusted, not broken 0 f. Mattress not worn out, cloth not torn, cotton/coir not 0 coming out

Drainage c. Drainage system not clogged 1

IV. Human Resource (Self improvement score)

Staff performance Baseline data (1st Subsequent visit survey) *

(monthly figure ) % improvement Number of deliveries conducted per SBA Number of OP cases per doctor 100/day Bed occupancy rate* Number of CS per Obstetrician Number of cataract operations per ophthalmologist Chest symptomatic sputum population examination rate Minor surgeries per doctor

Antenatal care severely anaemic (under 7 gm%) managed rate IUD insertions per trained nurse MTP services per trained doctor

o Indicative column; subsequent visits (2nd, 3rd etc. Would be scored on improvement and in a fresh inspection form) o Bed occupancy rate=(inpatient days of care/bed days available)×100

V. Services available (applicable for BPHCs and above)

Sl.no Service Means of verification Score 1. 24 hour doctor available Duty roster, casuality register 2 2. 24 hour nurse available Duty roster, casuality register 2

3. 24 hour delivery services Delivery register 2 available

4. 24 hour newborn care Delivery register, Paediatric ward register, services available Immunization register 5. 24 hour caesarean services Delivery register (if FRU)

6. Tubectomy services available FP register

7. Safe abortion services MTP register available 8. 24 hour blood transfusion Blood transfusion register / Blood bank master services register 9. Laboratory Services Equipments and reagents for conducting the tests 2 are present, lab record shows tests are conducted 11. Haemogram

12. Sputum Examination Lab register 13. Lipid Profile 14. Hormone Assay 15. Urine Examination

10. Availability of ECG Facility ECG machine available & working 11. X Ray Facility with X-ray X ray register – working status Technician available

12. Ultrasound services available USG register – working status

13. Ambulance Records of operation [Number of ambulances, average (if more than one ambulance) number of breakdowns in the last one week, number of drivers available per shift] maintained

Total=8 1. Functional telephone Telephone number with dial tone 1 2. Adolescent sexual and OP register – number of adolescent beneficiaries reproductive health services

3. Whether fixed day antenatal ANC register clinics are conducted 4. Whether fixed day RTI/STI OPD Register clinics are conducted 5. Whether fixed day Register sterilization clinics are conducted

6. Whether IEC material 1 displayed 7 Public Display of JSY Beneficiaries Total=2

VI. Services Out-Sourced

Sl. Item Means of verification Score no 1. House g. Floor is cleaned with disinfectant on the day of visit 1 keeping h. rainbow linen colour maintained 0 i. OT fumigated 0

2. Generator e. Generator in working condition with designated horse 1 power f. Fuel for operation present 0 1 3. Food e. Food served to inpatients 0 f. Food chart for inpatients Total=3

V) Equipments and supplies

Item MOV condition Score Trolley e. In working condition f. Trolley without rust 0

Wheelchair e. In working condition f. Wheelchair without rust 0

Stretcher e. Stretcher without rust f. not broken 1

Sterilised gloves Sterilised gloves available 1 Average number of OP drugs available (monthly) Drug stock register 3 Availability of life saving drugs present Availability of; 0

i. Oxytocin j. Misoprostol k. Magnesium Sulphate

l. IV antibiotics

Total=5

VIII. Equipments in Labour room

Equipment MOV Score 25. Spot light in labour room 1 26. Vacuum extractor

27. Resuscitation equipment for newborn – Bag and mask

28. Resuscitation equipment for newborn – Laryngoscope and full set of endo-tracheal tubes 29. Baby resuscitation table with infant warmer 30. Mucous sucker

31. Baby weighing machine 1 32. Partograph

33. Privacy in Labour room (curtains etc) 1 34. Toilet attached to Labour room 1 35. Protocols displayed: Active management of 3rd stage of labour (also check case sheets)

36. Labour board not rusted, not broken and not blood stained 1 Total=5

VII)Equipments in OT

Equipments MOV score 15. Ceiling OT light/ Floor OT light (shadowless) 1 16. Oxygen cylinder 1 17. Boyles apparatus (only FRU)

18. Suction apparatus 1 8 19. Adequate quantity of linen 20. Spinal anaesthesia set (FRU) 21. Ante room present Total=3

VIII)Bio-medical Waste Management

Item MOV Score Waste q. Colour coded buckets used 1 management r. Deep burial pit available where anatomical waste is disposed 1 s. Needle cutter in working condition t. no mix of infectious or non-infectious waste done 1 u. waste bins not overfilled v. needles and syringes mutilated and disinfected before 1 putting in waste bin w. metal sharps disposed in puncture proof containers 1 x. disposable gloves and masks not reused

8 3 sets of linen per surgery per day. (Calculate average number of surgeries per Day )

Total=8

IX) Central sterilization unit

MOV Score Autoclave i. Functioning autoclave ‘a’ carries 1 mark, j. Usage of signalac tape k. usage of biological indicator b / c / d (either) carries 1 mark l. swab test of sterile packs Total 2 marks

X) Records and reports

XI) Finance

Head Number of mothers yet to receive the JSY money Score

RKS Full utilization of funds in 2009-10 JSY JSY payments not pending till last week of the visit 2

Appendix 1

Inspection scoring sheet for health facilities

Name of the inspecting officer: Huma Siddiquee Date & time: ......

District: Dhaulpur Total marks: 125

Name of Facility (APHC/BPHC /Referral/ SD/Sadar): Saipau-CHC

Item Maximum Facility marks Score III. Infrastructure 34 18

IV. Human Resource Self improvement score

V. Services available (applicable for BPHCs and 33 10 above)

VI. Services Out-Sourced 7 3

V) Equipments and supplies 10 5 VI)Equipments in Labour room 12 5 VII)Equipments in OT 7 3 VIII) Bio-medical Waste Management 8 8 IX) Central sterilization unit 2 0 X) Records and reports 3 3 XI) Finance 4 2 Total Score 120 57

Form D: Inspection format for health facilities

Name of the Consultant:Huma Siddiquee Date & time: ......

District: Dhaulpur Total marks: 125

Name of Facility (APHC/BPHC /Referral/ SD/Sadar): Kanchanpura-PHC

16. No. of Doctors (with details of specialists available):2(1MO,1AYUSH) 17. No. of Nurses: Posted: Deputed: 18. No. of ANM’s: Posted: Deputed:

19. No. of SBA trained Personnel: 20. No. of Beds:6 Sanctioned:6 Functional:6 21. MCH beds:

IV. Infrastructure

Item MOV Criteria Score Building v. Walls and floor and roof intact 1 condition w. Electrical wires not exposed 1 x. Electric switch boards not broken 1 y. Electric bulbs in wards / pathways / toilets 1 z. Whitewashed 0 aa. Signage boards present 0 bb. Rooms not dumped with condemned articles 1 Total =5 Condition of p. Mosquito screens present and devoid of holes 0 wards q. Condemned articles not stored in the wards 1 r. window glasses not broken 1 s. Door / Screens / Curtains / present for ensuring privacy of 0 patient t. Availability of ceiling fans in wards 1 Total=3 Water supply p. Running water available for 24 hours in Labour room 0 q. Running water available for 24 hours in OT r. Running water available for 24 hours in Toilets 0 s. Purified drinking water available for drinking for patients in 0 OP 2 t. Purified drinking water available for drinking for patients in 2 IP Total=4

Condition of s. Doors are not damaged 1 toilets t. Floors are clean 0 u. Basins are not stained 0 v. water taps not damaged, 0 w. pathway is not dirty 0 x. Separate for male and female 1 Total=2 Patient j. Seating arrangements are present in the OPD area 1 amenities k. Stools or chairs for attendants in the wards present 1 l. Inpatients are provided with blankets in winter Total=2

Furniture g. Cots are not rusted, not broken 0 h. Mattress not worn out, cloth not torn, cotton/coir not 1 coming out Total=1

Drainage d. Drainage system not clogged 1

V. Human Resource (Self improvement score)

Staff performance Baseline data (1st Subsequent visit survey) *

(monthly figure ) % improvement Number of deliveries conducted per SBA Number of OP cases per doctor 25/day Bed occupancy rate* Number of CS per Obstetrician Number of cataract operations per ophthalmologist Chest symptomatic sputum population examination rate Minor surgeries per doctor Antenatal care severely anaemic (under 7 gm%) managed rate IUD insertions per trained nurse MTP services per trained doctor

o Indicative column; subsequent visits (2nd, 3rd etc. Would be scored on improvement and in a fresh inspection form) o Bed occupancy rate=(inpatient days of care/bed days available)×100

VI. Services available (applicable for BPHCs and above)

Sl.no Service Means of verification Score 1. 24 hour doctor available Duty roster, casuality register 2. 24 hour nurse available Duty roster, casuality register

3. 24 hour delivery services Delivery register

available Available 4. 24 hour newborn care Delivery register, Paediatric ward register, services get services available Immunization register 2 mark each 5. 24 hour caesarean services Delivery register 26 marks (if FRU) 6. Tubectomy services FP register available 7. Safe abortion services MTP register available 8. 24 hour blood transfusion Blood transfusion register / Blood bank services master register 9. Laboratory Services Equipments and reagents for conducting the tests are present, lab record shows tests are 16. Haemogram conducted 17. Sputum Examination 18. Lipid Profile Lab register 19. Hormone Assay 20. Urine Examination

10. Availability of ECG Facility ECG machine available & working 11. X Ray Facility with X-ray X ray register – working status Technician available 12. Ultrasound services USG register – working status available 13. Ambulance Records of operation [Number of ambulances, average (if more than one ambulance) number of breakdowns in the last one week, number of drivers available per shift] maintained 1. Functional telephone Telephone number with dial tone 2. Adolescent sexual and OP register – number of adolescent 7 X 1= 7 reproductive health services beneficiaries 3. Whether fixed day ANC register antenatal clinics are conducted 4. Whether fixed day RTI/STI OPD Register clinics are conducted 5. Whether fixed day Register sterilization clinics are

conducted 6. Whether IEC material displayed 7 Public Display of JSY Beneficiaries

VII. Services Out-Sourced

Sl. Item Means of verification Score no 1. House j. Floor is cleaned with disinfectant on the day of visit 1 keeping k. rainbow linen colour maintained 0 l. OT fumigated 0

2. Generator g. Generator in working condition with designated horse 1 power h. Fuel for operation present 0

1 3. Food g. Food served to inpatients h. Food chart for inpatients 0

Total=3

V) Equipments and supplies

Item MOV condition Score Trolley g. In working condition h. Trolley without rust 1

Wheelchair g. In working condition 0 h. Wheelchair without rust

Stretcher g. Stretcher without rust 1 h. not broken Total=2

Sterilised gloves Sterilised gloves available 1 Average number of OP drugs Drug stock register 2 available (monthly) Availability of life saving Availability of; Total 2 marks if all are drugs present present, if not 0. m. Oxytocin n. Misoprostol o. Magnesium Sulphate p. IV antibiotics

IX. Equipments in Labour room

Equipment MOV Score 37. Spot light in labour room 1 38. Vacuum extractor

39. Resuscitation equipment for newborn – Bag and mask

40. Resuscitation equipment for newborn – Laryngoscope and full set of endo-tracheal tubes 41. Baby resuscitation table with infant warmer 42. Mucous sucker

43. Baby weighing machine 1 44. Partograph

45. Privacy in Labour room (curtains etc) 1 46. Toilet attached to Labour room 1

47. Protocols displayed: Active management of 3rd stage of labour (also check case sheets)

48. Labour board not rusted, not broken and not blood stained Total=4

VII)Equipments in OT

Equipments MOV score 22. Ceiling OT light/ Floor OT light (shadowless) 1 23. Oxygen cylinder

24. Boyles apparatus (only FRU)

25. Suction apparatus 1 26. Adequate quantity of linen9 27. Spinal anaesthesia set (FRU) 28. Ante room present Total=2

VIII)Bio-medical Waste Management

Item MOV Score Waste y. Colour coded buckets used -1 Total=7 management z. Deep burial pit available where anatomical waste is disposed -0 aa. Needle cutter in working condition -1 bb. no mix of infectious or non-infectious waste done- 1 cc. waste bins not overfilled -1 dd. needles and syringes mutilated and disinfected before putting in waste bin -1 ee. metal sharps disposed in puncture proof containers- 1 ff. disposable gloves and masks not reused -1

IX) Central sterilization unit

MOV Score Autoclave m. Functioning autoclave ‘a’ carries 1 mark, n. Usage of signalac tape o. usage of biological indicator b / c / d (either) carries 1 mark p. swab test of sterile packs Total 2 marks

X) Records and reports

9 3 sets of linen per surgery per day. (Calculate average number of surgeries per Day )

XI) Finance

Head Number of mothers yet to receive the JSY money Score

RKS Full utilization of funds in 2009-10 0 JSY JSY payments not pending till last week of the visit 2 Total=2

Appendix 1

Inspection scoring sheet for health facilities

Name of the inspecting officer: Huma Siddiquee Date & time: ......

District: Dhaulpur Total marks: 125

Name of Facility (APHC/BPHC /Referral/ SD/Sadar): Kanchanpura-PHC

Item Maximum Facility marks Score IV. Infrastructure 34 18

V. Human Resource Self improvement score

VI. Services available (applicable for BPHCs and 33 above)

VII. Services Out-Sourced 7 3

V) Equipments and supplies 10 5/8 VI)Equipments in Labour room 12 4 VII)Equipments in OT 7 2 VIII) Bio-medical Waste Management 8 7 IX) Central sterilization unit 2 X) Records and reports 3 3 XI) Finance 4 2 Total Score 120 44/83

Form D: Inspection format for health facilities

Name of the Consultant:Huma Siddiquee Date & time : ......

District: Dhaulpur Total marks: 125

Name of Facility (APHC/BPHC /Referral/ SD/Sadar): Pachgaon-PHC

22. No. of Doctors (with details of specialists available): 23. No. of Nurses: Posted: Deputed: 24. No. of ANM’s: Posted: Deputed: 25. No. of SBA trained Personnel: 26. No. of Beds: 6 Sanctioned:6 Functional:6 MCH beds:

V. Infrastructure

Item MOV Criteria Score Building cc. Walls and floor and roof intact 1 condition dd. Electrical wires not exposed 0 ee. Electric switch boards not broken 0 ff. Electric bulbs in wards / pathways / toilets 0 gg. Whitewashed 0 hh. Signage boards present 0 ii. Rooms not dumped with condemned articles 0 Total=1 Condition of u. Mosquito screens present and devoid of holes 0 wards v. Condemned articles not stored in the wards 0 w. window glasses not broken 0

x. Door / Screens / Curtains / present for ensuring privacy of 0 patient y. Availability of ceiling fans in wards 1 Total=1 Water supply u. Running water available for 24 hours in Labour room 0 v. Running water available for 24 hours in OT w. Running water available for 24 hours in Toilets 0 x. Purified drinking water available for drinking for patients in 2 OP 0 y. Purified drinking water available for drinking for patients in 0 IP Total=2

Condition of y. Doors are not damaged 1 toilets z. Floors are clean 1 aa. Basins are not stained 0 bb. water taps not damaged, 0 cc. pathway is not dirty 1 dd. Separate for male and female 1 Total=4 Patient m. Seating arrangements are present in the OPD area 0 amenities n. Stools or chairs for attendants in the wards present 0 o. Inpatients are provided with blankets in winter 0

Furniture i. Cots are not rusted, not broken 0 j. Mattress not worn out, cloth not torn, cotton/coir not 0 coming out

Drainage e. Drainage system not clogged 0

VI. Human Resource (Self improvement score)

Staff performance Baseline data (1st Subsequent visit survey) *

(monthly figure ) % improvement Number of deliveries conducted per SBA Number of OP cases per doctor 25/day Bed occupancy rate* Number of CS per Obstetrician

Number of cataract operations per ophthalmologist Chest symptomatic sputum population examination rate Minor surgeries per doctor Antenatal care severely anaemic (under 7 gm%) managed rate IUD insertions per trained nurse MTP services per trained doctor

o Indicative column; subsequent visits (2nd, 3rd etc. Would be scored on improvement and in a fresh inspection form) o Bed occupancy rate=(inpatient days of care/bed days available)×100

VII. Services available (applicable for BPHCs and above)

Sl.no Service Means of verification Score 1. 24 hour doctor available Duty roster, casuality register 2. 24 hour nurse available Duty roster, casuality register

3. 24 hour delivery services Delivery register Available available services get 4. 24 hour newborn care Delivery register, Paediatric ward register, 2 mark each services available Immunization register 5. 24 hour caesarean services Delivery register 26 marks (if FRU) 6. Tubectomy services FP register available 7. Safe abortion services MTP register available 8. 24 hour blood transfusion Blood transfusion register / Blood bank services master register 9. Laboratory Services Equipments and reagents for conducting the tests are present, lab record shows tests are 21. Haemogram conducted 22. Sputum Examination 23. Lipid Profile Lab register 24. Hormone Assay

25. Urine Examination

VIII. Services Out-Sourced

Sl. Item Means of verification Score no 1. House m. Floor is cleaned with disinfectant on the day of visit 0 keeping n. rainbow linen colour maintained 0 o. OT fumigated 0

2. Generator i. Generator in working condition with designated horse 0 power

j. Fuel for operation present 0 3. Food i. Food served to inpatients 0 j. Food chart for inpatients 0

V) Equipments and supplies

Item MOV condition Score Trolley i. In working condition j. Trolley without rust 0

Wheelchair i. In working condition 0 j. Wheelchair without rust

Stretcher i. Stretcher without rust j. not broken 1

Sterilised gloves Sterilised gloves available 1 Average number of OP drugs Drug stock register 2 available (monthly) Availability of life saving Availability of; Total 2 marks if all are drugs present present, if not 0. q. Oxytocin r. Misoprostol s. Magnesium Sulphate t. IV antibiotics

X. Equipments in Labour room

Equipment MOV Score 49. Spot light in labour room 1 50. Vacuum extractor

51. Resuscitation equipment for newborn – Bag and mask

52. Resuscitation equipment for newborn – Laryngoscope and full set of endo-tracheal tubes 53. Baby resuscitation table with infant warmer

54. Mucous sucker

55. Baby weighing machine 1 56. Partograph

57. Privacy in Labour room (curtains etc) 1 58. Toilet attached to Labour room

59. Protocols displayed: Active management of 3rd stage of labour (also check case sheets)

60. Labour board not rusted, not broken and not blood stained 1 Total=4

VII)Equipments in OT

Equipments MOV score 29. Ceiling OT light/ Floor OT light (shadowless) 1 30. Oxygen cylinder 31. Boyles apparatus (only FRU)

32. Suction apparatus 1 10 33. Adequate quantity of linen 34. Spinal anaesthesia set (FRU) 35. Ante room present Total=2

VIII)Bio-medical Waste Management

Item MOV Score Waste gg. Colour coded buckets used 1 management hh. Deep burial pit available where anatomical waste is disposed 0

10 3 sets of linen per surgery per day. (Calculate average number of surgeries per Day )

ii. Needle cutter in working condition 1 jj. no mix of infectious or non-infectious waste done kk. waste bins not overfilled 1 ll. needles and syringes mutilated and disinfected before putting in waste bin 1 mm. metal sharps disposed in puncture proof containers nn. disposable gloves and masks not reused 1

Total=7

IX) Central sterilization unit

MOV Score Autoclave q. Functioning autoclave ‘a’ carries 1 mark, r. Usage of signalac tape s. usage of biological indicator b / c / d (either) carries 1 mark t. swab test of sterile packs Total 2 marks

X) Records and reports

Referral slips are issued to patients 1 Total=3

XI) Finance

Head Number of mothers yet to receive the JSY money Score

RKS Full utilization of funds in 2009-10 0 JSY JSY payments not pending till last week of the visit 2 Total=2

Appendix 1

Inspection scoring sheet for health facilities

Name of the inspecting officer: Huma Siddiquee Date & time: ......

District: Dhaulpur Total marks: 125

Name of Facility (APHC/BPHC /Referral/ SD/Sadar): Pachgaon-PHC

Item Maximum Facility marks Score V. Infrastructure 34 8

VI. Human Resource Self improvement score

VII. Services available (applicable for BPHCs and 33 above)

VIII. Services Out-Sourced 7 0

V) Equipments and supplies 10 4/8 VI)Equipments in Labour room 12 4 VII)Equipments in OT 7 2 VIII) Bio-medical Waste Management 8 7 IX) Central sterilization unit 2 X) Records and reports 3 3 XI) Finance 4 2 Total Score 120 30/83

Form D: Inspection format for health facilities

Name of the Consultant: Huma Siddiquee Date & time : ......

District: Dhaulpur Total marks: 125

Name of Facility (APHC/BPHC /Referral/ SD/Sadar): Saranikhera -PHC

27. No. of Doctors (with details of specialists available):2 (1 MO , 1 AYUSH) 28. No. of Nurses: Posted:1 Male Nurse, 2 GNM, 1LHV Deputed: 29. No. of ANM’s: Posted: Deputed: 30. No. of SBA trained Personnel: 31. No. of Beds: Sanctioned: Functional: MCH beds:

VI. Infrastructure

Item MOV Criteria Score Building jj. Walls and floor and roof intact 1 condition kk. Electrical wires not exposed 1 ll. Electric switch boards not broken 1 mm. Electric bulbs in wards / pathways / toilets 1 nn. Whitewashed 1 oo. Signage boards present pp. Rooms not dumped with condemned articles 1 1 Total = 7 Condition of z. Mosquito screens present and devoid of holes 0 wards aa. Condemned articles not stored in the wards 1 bb. window glasses not broken 1 cc. Door / Screens / Curtains / present for ensuring privacy of 1 patient 1 dd. Availability of ceiling fans in wards Total=4

Water supply z. Running water available for 24 hours in Labour room 1 aa. Running water available for 24 hours in OT bb. Running water available for 24 hours in Toilets cc. Purified drinking water available for drinking for patients in 1

OP 1 dd. Purified drinking water available for drinking for patients in IP 1 Total=4 Condition of ee. Doors are not damaged 1 toilets ff. Floors are clean 1 gg. Basins are not stained 0 hh. water taps not damaged, 0 ii. pathway is not dirty 0 jj. Separate for male and female 1 Total=3 Patient p. Seating arrangements are present in the OPD area 1 amenities q. Stools or chairs for attendants in the wards present 1 r. Inpatients are provided with blankets in winter 0 Total=2 Furniture k. Cots are not rusted, not broken 1 l. Mattress not worn out, cloth not torn, cotton/coir not 0 coming out Total=1

Drainage f. Drainage system not clogged 1 Total=1

VII. Human Resource (Self improvement score)

Staff performance Baseline data (1st Subsequent visit survey) *

(monthly figure ) % improvement Number of deliveries conducted per SBA NA Number of OP cases per doctor 35 Bed occupancy rate* Number of CS per Obstetrician NA Number of cataract operations per NA ophthalmologist Chest symptomatic sputum population examination rate Minor surgeries per doctor Antenatal care severely anaemic (under 7 gm%) managed rate IUD insertions per trained nurse

MTP services per trained doctor

o Indicative column; subsequent visits (2nd, 3rd etc. Would be scored on improvement and in a fresh inspection form) o Bed occupancy rate=(inpatient days of care/bed days available)×100

VIII. Services available (applicable for BPHCs and above)

Sl.no Service Means of verification Score 1. 24 hour doctor available Duty roster, casuality register 2. 24 hour nurse available Duty roster, casuality register

3. 24 hour delivery services Delivery register Available available services get 4. 24 hour newborn care Delivery register, Paediatric ward register, 2 mark each services available Immunization register 5. 24 hour caesarean services Delivery register 26 marks (if FRU) 6. Tubectomy services FP register available 7. Safe abortion services MTP register available 8. 24 hour blood transfusion Blood transfusion register / Blood bank services master register 9. Laboratory Services Equipments and reagents for conducting the tests are present, lab record shows tests are 26. Haemogram conducted 27. Sputum Examination 28. Lipid Profile Lab register 29. Hormone Assay 30. Urine Examination

ambulance) number of breakdowns in the last one week, number of drivers available per shift] maintained 1. Functional telephone Telephone number with dial tone 2. Adolescent sexual and OP register – number of adolescent 7 X 1= 7 reproductive health services beneficiaries 3. Whether fixed day ANC register antenatal clinics are conducted 4. Whether fixed day RTI/STI OPD Register clinics are conducted 5. Whether fixed day Register sterilization clinics are conducted 6. Whether IEC material displayed 7 Public Display of JSY Beneficiaries

IX. Services Out-Sourced

Sl. Item Means of verification Score no 1. House p. Floor is cleaned with disinfectant on the day of visit 1 keeping q. rainbow linen colour maintained 1 r. OT fumigated 1

2. Generator k. Generator in working condition with designated horse 1 power 1 l. Fuel for operation present

3. Food k. Food served to inpatients 1

l. Food chart for inpatients 0

Total=6

V) Equipments and supplies

Item MOV condition Score Trolley k. In working condition l. Trolley without rust 0 Wheelchair k. In working condition l. Wheelchair without rust 0 Stretcher k. Stretcher without rust l. not broken

Sterilised gloves Sterilised gloves available 1 Average number of OP drugs available (monthly) Drug stock register 3 Availability of life saving drugs present Availability of; NA

u. Oxytocin v. Misoprostol w. Magnesium Sulphate x. IV antibiotics

XI. Equipments in Labour room

Equipment MOV Score 61. Spot light in labour room 1 62. Vacuum extractor 0

63. Resuscitation equipment for newborn – Bag and mask 0

64. Resuscitation equipment for newborn – Laryngoscope and full set of 0

endo-tracheal tubes 65. Baby resuscitation table with infant warmer 0 66. Mucous sucker 0 67. Baby weighing machine 1

68. Partograph 0 69. Privacy in Labour room (curtains etc)

70. Toilet attached to Labour room 1

71. Protocols displayed: Active management of 3rd stage of labour (also check 0 case sheets)

72. Labour board not rusted, not broken and not blood stained 1 Total=5

VII)Equipments in OT

Equipments MOV score 36. Ceiling OT light/ Floor OT light (shadowless) 1 37. Oxygen cylinder 1 38. Boyles apparatus (only FRU)

39. Suction apparatus 1 11 40. Adequate quantity of linen 1 41. Spinal anaesthesia set (FRU)

42. Ante room present 0 Total=4

VIII)Bio-medical Waste Management

Item MOV Score Waste oo. Colour coded buckets used 1 management pp. Deep burial pit available where anatomical waste is disposed 1 qq. Needle cutter in working condition rr. no mix of infectious or non-infectious waste done 1 ss. waste bins not overfilled tt. needles and syringes mutilated and disinfected before

11 3 sets of linen per surgery per day. (Calculate average number of surgeries per Day )

putting in waste bin 1

1 uu. metal sharps disposed in puncture proof containers 1

Total=8 vv. disposable gloves and masks not reused

IX) Central sterilization unit

MOV Score Autoclave u. Functioning autoclave ‘a’ carries 1 mark, v. Usage of signalac tape w. usage of biological indicator b / c / d (either) carries 1 mark x. swab test of sterile packs Total 2 marks

X) Records and reports

Item MOV score Separate column (in delivery register) for recording major complications leading 1 to maternal death Delivery register mentions about the details of the baby and condition of the 1 mother

Referral slips are issued to patients 1 Total=3

XI) Finance

Head Number of mothers yet to receive the JSY money Score

RKS Full utilization of funds in 2009-10 0 JSY JSY payments not pending till last week of the visit 2 Total=2

Appendix 1

Inspection scoring sheet for health facilities

Name of the inspecting officer: Huma Siddiquee Date & time: ......

District:Dhaulpur Total marks: 125

Name of Facility (APHC/BPHC /Referral/ SD/Sadar):Saraikhera-PHC

Item Maximum Facility marks Score VI. Infrastructure 34 22

VII. Human Resource Self improvement score

VIII. Services available (applicable for BPHCs and 33 above)

IX. Services Out-Sourced 7 6

V) Equipments and supplies 10 4/8 VI)Equipments in Labour room 12 5 VII)Equipments in OT 7 4 VIII) Bio-medical Waste Management 8 8 IX) Central sterilization unit 2 X) Records and reports 3 3 XI) Finance 4 2 Total Score 120 54/83

Form D: Inspection format for health facilities

Name of the Consultant: Huma Siddiquee Date & time: ......

District: Dhaulpur Total marks: 125

Name of Facility (APHC/BPHC /Referral/ SD/Sadar): Tasimo-PHC

32. No. of Doctors (with details of specialists available): 33. No. of Nurses: Posted: Deputed: 34. No. of ANM’s: Posted: Deputed: 35. No. of SBA trained Personnel: 36. No. of Beds:10 Sanctioned:10 Functional:10 MCH beds:

VII. Infrastructure

Item MOV Criteria Score Building qq. Walls and floor and roof intact 1 condition rr. Electrical wires not exposed 1 ss. Electric switch boards not broken 1 tt. Electric bulbs in wards / pathways / toilets 1 uu. Whitewashed 0 vv. Signage boards present ww. Rooms not dumped with condemned articles 0 0 Total =4 Condition of ee. Mosquito screens present and devoid of holes 0 wards ff. Condemned articles not stored in the wards 1 gg. window glasses not broken 1 hh. Door / Screens / Curtains / present for ensuring privacy of 0 patient ii. Availability of ceiling fans in wards 1 Total=3 Water supply ee. Running water available for 24 hours in Labour room 0 ff. Running water available for 24 hours in OT gg. Running water available for 24 hours in Toilets 0 hh. Purified drinking water available for drinking for patients in 0 OP 2 ii. Purified drinking water available for drinking for patients in IP 0 Total=2

Condition of kk. Doors are not damaged 0 toilets ll. Floors are clean 0 mm. Basins are not stained 0 nn. water taps not damaged, 0 oo. pathway is not dirty 0 pp. Separate for male and female 1 Total=1 Patient s. Seating arrangements are present in the OPD area 1 amenities t. Stools or chairs for attendants in the wards present 1 u. Inpatients are provided with blankets in winter 0 Total=2

Furniture m. Cots are not rusted, not broken 0 n. Mattress not worn out, cloth not torn, cotton/coir not 0 coming out

Drainage g. Drainage system not clogged 1

VIII. Human Resource (Self improvement score)

Staff performance Baseline data (1st Subsequent visit survey) *

(monthly figure ) % improvement Number of deliveries conducted per SBA 15/year Number of OP cases per doctor 30/day Bed occupancy rate* Number of CS per Obstetrician Number of cataract operations per ophthalmologist Chest symptomatic sputum population examination rate Minor surgeries per doctor Antenatal care severely anaemic (under 7 gm%) managed rate IUD insertions per trained nurse MTP services per trained doctor

o Indicative column; subsequent visits (2nd, 3rd etc. Would be scored on improvement and in a fresh inspection form) o Bed occupancy rate=(inpatient days of care/bed days available)×100

IX. Services available (applicable for BPHCs and above)

Sl.no Service Means of verification Score 1. 24 hour doctor available Duty roster, casuality register 2. 24 hour nurse available Duty roster, casuality register

3. 24 hour delivery services Delivery register Available available services get 4. 24 hour newborn care Delivery register, Paediatric ward register, 2 mark each services available Immunization register 5. 24 hour caesarean services Delivery register 26 marks (if FRU) 6. Tubectomy services FP register available 7. Safe abortion services MTP register available 8. 24 hour blood transfusion Blood transfusion register / Blood bank services master register 9. Laboratory Services Equipments and reagents for conducting the tests are present, lab record shows tests are 31. Haemogram conducted 32. Sputum Examination 33. Lipid Profile Lab register 34. Hormone Assay 35. Urine Examination

per shift] maintained 1. Functional telephone Telephone number with dial tone 2. Adolescent sexual and OP register – number of adolescent 7 X 1= 7 reproductive health services beneficiaries 3. Whether fixed day ANC register antenatal clinics are conducted 4. Whether fixed day RTI/STI OPD Register clinics are conducted 5. Whether fixed day Register sterilization clinics are conducted 6. Whether IEC material displayed 7 Public Display of JSY Beneficiaries

X. Services Out-Sourced

Sl. Item Means of verification Score no 1. House s. Floor is cleaned with disinfectant on the day of visit 1 keeping t. rainbow linen colour maintained 0 u. OT fumigated 0

2. Generator m. Generator in working condition with designated horse 1 power n. Fuel for operation present 0

3. Food m. Food served to inpatients 1 n. Food chart for inpatients 0 Total=3

V) Equipments and supplies

Item MOV condition Score Trolley m. In working condition 0 n. Trolley without rust

Wheelchair m. In working condition 0 n. Wheelchair without rust

Stretcher m. Stretcher without rust 1 n. not broken

Total=1 Sterilised gloves Sterilised gloves available 1 Average number of OP drugs Drug stock register 2 available (monthly) Availability of life saving Availability of; Total 2 marks if all are drugs present present, if not 0. y. Oxytocin z. Misoprostol aa. Magnesium Sulphate bb. IV antibiotics

XII. Equipments in Labour room

Equipment MOV Score 73. Spot light in labour room 1 74. Vacuum extractor

75. Resuscitation equipment for newborn – Bag and mask

76. Resuscitation equipment for newborn – Laryngoscope and full set of endo-tracheal tubes 77. Baby resuscitation table with infant warmer 78. Mucous sucker 1 79. Baby weighing machine 80. Partograph

81. Privacy in Labour room (curtains etc)

82. Toilet attached to Labour room

1 83. Protocols displayed: Active management of 3rd stage of labour (also check case sheets)

84. Labour board not rusted, not broken and not blood stained 1 Total=4

VII)Equipments in OT

Equipments MOV score 43. Ceiling OT light/ Floor OT light (shadowless) 0 44. Oxygen cylinder 45. Boyles apparatus (only FRU) 46. Suction apparatus 47. Adequate quantity of linen12 48. Spinal anaesthesia set (FRU) 49. Ante room present

VIII)Bio-medical Waste Management

Item MOV Score Waste ww. Colour coded buckets used 1 management xx. Deep burial pit available where anatomical waste is disposed 1 yy. Needle cutter in working condition zz. no mix of infectious or non-infectious waste done 1 aaa. waste bins not overfilled bbb. needles and syringes mutilated and disinfected 1 before putting in waste bin ccc. metal sharps disposed in puncture proof containers 1 ddd. disposable gloves and masks not reused

12 3 sets of linen per surgery per day. (Calculate average number of surgeries per Day )

Total:8

IX) Central sterilization unit

MOV Score Autoclave y. Functioning autoclave ‘a’ carries 1 mark, z. Usage of signalac tape aa. usage of biological indicator b / c / d (either) carries 1 mark bb. swab test of sterile packs Total 2 marks

X) Records and reports

Total=3

XI) Finance

Head Number of mothers yet to receive the JSY money Score

RKS Full utilization of funds in 2009-10 JSY JSY payments not pending till last week of the visit 2 Total=2

Appendix 1

Inspection scoring sheet for health facilities

Name of the inspecting officer: Huma Siddiquee Date & time: ......

District: Dhaulpur Total marks: 125

Name of Facility (APHC/BPHC /Referral/ SD/Sadar):Tasimo-PHC

Item Maximum Facility marks Score VII. Infrastructure 34 13

VIII. Human Resource Self improvement score

IX. Services available (applicable for BPHCs and 33 above)

X. Services Out-Sourced 7 3

V) Equipments and supplies 10 4/8 VI)Equipments in Labour room 12 4 VII)Equipments in OT 7 0 VIII) Bio-medical Waste Management 8 8 IX) Central sterilization unit 2 X) Records and reports 3 3 XI) Finance 4 2 Total Score 120 37/83

Form E: Supportive Supervision

Name of the inspecting officer: Huma Siddiquee Date & time: ......

District: Dhaulpur Total marks: 90

Location of Facility:Boreli Building: Govt./private

Stay in the SHC – Yes If no place of residence & distance form SHC -- km

SBA trained yes Conduct deliveries in the HSC / Supervised deliveries at home/ both

Expected deliveries in the HSC area ...... % of exp. deliveries conducted by the ANM

Electricity available / NA

Item MOV Criteria Score Building condition a) Walls and floor and roof intact 2 b) Electrical wires not exposed 2 c) Electric switch boards not broken 2 d) Whitewashed 2 e) overhead tank and running water 0 available f) electricity available 0 g) floor is clean on the day of visit 2 h) ANM stay in the SHC 5 Total=15 Condition of toilets a) Doors are not damaged 2 b) Floors are clean & Basins are not 0 stained c) Running water present 3 Total=5 Services & performance a) Services offered and timings 10 displayed b) Pregnant women and infant 2 tracking register maintained c) Micro plan for VHNDs available; at 0 least 90% of planned VHNDs held in the last quarter d) Nischay kit available 2 e) Kit A and B available* 2

Item MOV Criteria Score f) Delivery kit available (at least 2) 0 g) Weighing machine (mother / baby) 2 and BP apparatus (and stethoscope) available h) Hb estimations done 2 i) Male worker present 0 j) Records of vector control activities 0 undertaken present (spraying, blood slides etc.) k) HMIS/IDSP formats getting 0 reported 10 l) ANM stays in the SHC 10 m) SHC conducts deliveries 5 n) The ANM is SBA trained 0 o) 2nd ANM present 2 p) Immunization cards updated Total – 47 Biomedical Waste a) Colour coded buckets used 0 Management b) Deep burial pit available where 0 anatomical waste is disposed (if the SHC conducts deliveries) c) Needle cutter in working condition 2 Total – 2 *Look for paracetamol and cotrimoxazole

Qualitative responses

1. Whether SHC untied funds have been utilized for facility improvement

Yes, Boudaries constructed around the sub centre building.

2. Check whether the ANM is using Nishay kits and whether she is aware of the way they are to be used.

3. Check the VHND micro plan for the last three months and check whether VHND’s have been conducted as per the schedule by verification in the registers.

4. Grievances / suggestions mentioned in the grievances box Serial Grievance Addressed at which level (Facility number level / district level / state level)

5. Any suggestions / reflections that the ANM want to make

Need of inverter for power back up

Appendix 1

Inspection scoring sheet for health facilities [Common format for Inspecting Officer and ANM of the SHC]

Name of the inspecting officer:Huma Siddiquee Date & time: ......

District:Dhaulpur Total marks: 100

Location of the SHC: Boreli

Item Maximum score SHC score

Building condition 25 15

Condition of toilets 7 5

Services & performance 62 47

Biomedical Waste Management 6 2

Total Score 100 69

Form E: Supportive Supervision

Inspection format for SHCs [Common format for Inspecting Officer and ANM of the Inspected facility]

Name of the inspecting officer: Huma Siddiquee Date & time: ......

District: Dhaulpur Total marks: 90

Location of Facility: Japawali Building: Govt./private

Stay in the SHC – No If no place of residence & distance form SHC -10- km

SBA trained -no Conduct deliveries in the HSC / Supervised deliveries at home/ both

Expected deliveries in the HSC area ...... % of exp. deliveries conducted by the ANM

Electricity available / NA

Item MOV Criteria Score Building condition i) Walls and floor and roof intact 1 j) Electrical wires not exposed 2 k) Electric switch boards not broken 2 l) Whitewashed 1 m) overhead tank and running 0 water available n) electricity available 1 o) floor is clean on the day of visit 2 p) ANM stay in the SHC 0 Total –9 marks Condition of toilets d) Doors are not damaged 1 e) Floors are clean & Basins are not 0 stained 0 f) Running water present Total- 1 marks Services & performance q) Services offered and timings 0 displayed

Item MOV Criteria Score r) Pregnant women and infant 1 tracking register maintained s) Micro plan for VHNDs available; at 1 least 90% of planned VHNDs held in the last quarter t) Nischay kit available 2 u) Kit A and B available* 2 v) Delivery kit available (at least 2) 1 w) Weighing machine (mother / baby) 2 and BP apparatus (and stethoscope) available x) Hb estimations done 0 y) Male worker present 0 z) Records of vector control activities 0 undertaken present (spraying, blood slides etc.) aa) HMIS/IDSP formats getting 0 reported 0 bb) ANM stays in the SHC 0 cc) SHC conducts deliveries 0 dd) The ANM is SBA trained 0 ee) 2nd ANM present 2 ff) Immunization cards updated Total – 11 marks Biomedical Waste d) Colour coded buckets used 0 Management e) Deep burial pit available where 0 anatomical waste is disposed (if the SHC conducts deliveries) f) Needle cutter in working condition 2 Total – 2marks *Look for paracetamol and cotrimoxazole

100

Qualitative responses

6. Whether SHC untied funds have been utilized for facility improvement

......

7. Check whether the ANM is using Nishay kits and whether she is aware of the way they are to be used.

8. Check the VHND micro plan for the last three months and check whether VHND’s have been conducted as per the schedule by verification in the registers.

9. Grievances / suggestions mentioned in the grievances box Serial Grievance Addressed at which level (Facility number level / district level / state level)

10. Any suggestions / reflections that the ANM want to make

………………………………………………………………………………………………………………………………………………

......

Appendix 1

Inspection scoring sheet for health facilities [Common format for Inspecting Officer and ANM of the SHC]

Name of the inspecting officer: Huma Siddiquee

District: Dhaulpur Total marks: 100

Location of the SHC: Japawali

101

Item Maximum score SHC score

Building condition 25 9

Condition of toilets 7 1

Services & performance 62 11

Biomedical Waste Management 6 2

Total Score 100 23

Form E: Supportive Supervision

Inspection format for SHCs [Common format for Inspecting Officer and ANM of the Inspected facility]

Name of the inspecting officer: Huma Siddiquee Date & time: ......

District: Dhaulpur Total marks: 90

Location of Facility: Karimpur Building: Govt./private

Stay in the SHC – Yes

If no place of residence & distance form SHC -- km

SBA trained yes

Conduct deliveries in the HSC / Supervised deliveries at home/ both- Both

Expected deliveries in the HSC area ...... % of exp. deliveries conducted by the ANM

Electricity available / NA - No

Item MOV Criteria Score Building condition q) Walls and floor and roof intact 1 r) Electrical wires not exposed 2

102

Item MOV Criteria Score s) Electric switch boards not broken 1 t) Whitewashed 1 u) overhead tank and running water 0 available v) electricity available 0 w) floor is clean on the day of visit 1 x) ANM stay in the SHC 5 Total –11 marks Condition of toilets g) Doors are not damaged 2 h) Floors are clean & Basins are not 1 stained i) Running water present 0 Total- 3marks Services & performance gg) Services offered and timings 0 displayed hh) Pregnant women and infant 2 tracking register maintained ii) Micro plan for VHNDs available; at 0 least 90% of planned VHNDs held in the last quarter jj) Nischay kit available 2 kk) Kit A and B available* 2 ll) Delivery kit available (at least 2) 1 mm) Weighing machine (mother / 2 baby) and BP apparatus (and stethoscope) available nn) Hb estimations done 0 oo) Male worker present 0 pp) Records of vector control 1 activities undertaken present

103

Item MOV Criteria Score (spraying, blood slides etc.) qq) HMIS/IDSP formats getting 1 reported 10 rr) ANM stays in the SHC 10 ss) SHC conducts deliveries 5 tt) The ANM is SBA trained 0 uu) 2nd ANM present 2 vv) Immunization cards updated Total –38marks Biomedical Waste g) Colour coded buckets used 0 Management h) Deep burial pit available where 0 anatomical waste is disposed (if the SHC conducts deliveries) i) Needle cutter in working condition 2 Total – 2 marks *Look for paracetamol and cotrimoxazole

Qualitative responses

11. Whether SHC untied funds have been utilized for facility improvement

......

Untied Fund is not properly utilised in facility improvement.

......

12. Check whether the ANM is using Nishay kits and whether she is aware of the way they are to be used.

13. Check the VHND micro plan for the last three months and check whether VHND’s have been conducted as per the schedule by verification in the registers.

14. Grievances / suggestions mentioned in the grievances box

104

Serial Grievance Addressed at which level (Facility number level / district level / state level)

15. Any suggestions / reflections that the ANM want to make

Electricity connection is there but most of the times power cut problem so provision of inverter should be there. …………………………………………………………………………………………………………………………………………… Water tank to be built in the sub centre building......

Appendix 1

Inspection scoring sheet for health facilities [Common format for Inspecting Officer and ANM of the SHC]

Name of the inspecting officer: Huma Siddiquee

District: dholpur Total marks: 100

Location of the SHC: Karimpur

Item Maximum score SHC score

Building condition 25 11

Condition of toilets 7 3

Services & performance 62 38

Biomedical Waste Management 6 2

Total Score 100 54

105