SSttaattee RReevviieeww MMiissssiioonn
(Supportive Super vision)
DISTRICT – BILASPUR IINNDDEEXX
1. BILASPUR DISTRICT PROFILE ...... 2 2. PRIMARY HEALTH CENTRE, TENGANMAR ...... 7 3. PRIMARY HEALTH CENTRE , SIPAT...... 16 4. COMMUNITY HEALTH CENTER, BILHA ...... 27 5. COMMUNITY HEALTH CENTER,MASTURI ...... 44
6. DISTRICT HOSPITAL, BILASPUR ...... 61
Page 1 Aim – The aims of supportive supervision are the collective efforts to find out the strength of health facility as well as the gaps and provide handholding support to the facility by team to operationalize with available resource.
Objective –
1. Constitution of joint team 2. Schedule field visit 3. Observation and recording the gaps 4. critical Analysis 5. supportive supervision 6. Documentation 7. Dissemination of findings and action taken 8. Follow-up and continuation of support
1. Team members :-
S.N. Name Designation Institute/Department /organization
1 Dr. khemraj Sonwani Deputy Director Dept.Health & FW
2 Mr. Anand Kumar Prog Manager M&E NRHM Sahu
3 Medical College Dr. Anjana PG Student, PSM Raipur 4 Programme Mr. Mithun Dutta Cordinator(Quality DHS Assurance)
5 Dr. Nilesh Sharma Consultant - UNICEF
Page 2 BILASPUR DISTRICT PROFILE
1. Bilaspur Profile:
Indicators Chhattisgarh Bilaspur
Total Population (In lakhs) (Census 2011) 256 Lakh 19.61 Lakh
Rural Population (In lakhs) (Census 2011) 196.08Lakh 13.47 Lakh
Number of Sub Division/ Talukas (Census 2011) 149 11 10 Number of Blocks (RHS 2012) 146
Number of Villages (Census 2011) 20126 1599 1 Number of District Hospitals (RHS 2012) 17
Number of Community Health Centres (RHS 2012) 149 10 80 Number of Primary Health Centres (RHS 2012) 755
Number of Sub Centres (RHS 2012) 5111 346
2. Status of Health Indicators
Sl. Bilaspur (AHS Indicators Chhattisgarh No 2011)
1 Infant Mortality Rate (SRS- 2012) 48 46
2 Maternal Mortality Ratio (SRS 2007-09) 269 293
3 Total Fertility Rate (SRS 2011) 2.9 3.2
4 Under-five Mortality Rate (SRS 2011) 66 60 Institutional Deliveries(In %) 5 34.9 21.9 (AHS 2011) Full immunisation (In %) 6 74.1 63.5 (AHS 2011)
Page 3 3. Demographic Profile
Indicator Chhattisgarh Bilaspur (AHS 2011)
Total Population (Census 2011) (In Crore) 2.56 crores 0.266 Crore
Crude Birth Rate (SRS 2011) 23.9 26.2
Crude Death Rate (SRS 2011) 7.6 7.5
Natural Growth Rate (SRS 2011) 16.3 18.7
Sex Ratio (Census 2011) 991 972
Child Sex Ratio (Census 2011) 964 957
Total Literacy Rate (%) (Census 2011) 71.04 71.59
Male Literacy Rate (%) (Census 2011) 81.45 82.77
Female Literacy Rate (%) (Census 2011) 60.59 60.12
4. Information on selected MCH indicators (Source AHS 2010-11)
Indicators Chhattisgarh Bilaspur (AHS-2011) Child feeding practices (%) Children under breastfed within one hour of 63.9 51.7 birth(15-44) Children age 6-35 months exclusively 47.5 38.7 breastfed for at least 6 months Avg Month by Children Received Foods other than Breast Milk(Animal or Formula 4.8 5.1 Milk) Awareness about Diarrhoea and ARI Women aware about danger signs of ARI 89.8 93 (%)(15-44) Treatment of childhood diseases Children with diarrhoea in the last 2 weeks 89.3 89 who received ORS (%)(15-44) Children with ARI in the last 2 weeks who 93.2 96.1 sought treatment (%)(15-44)
Page 4 5. RoP Approvals in FY 2013-14 (As per District RoP approved by State)
Summary of Approvals for Alwar District (FY 2013-14)
FMR Activity Amount (in lakhs) A RCH 1461.47 B MISSION 1069.25 C Immunization 144.83 D NIDDCP 00 E IDSP 12.89 F NVBDCP 26.14 G NLEP 14.83 H RNTCP 64.03 Total 2793.44
3. Progress of NRHM in Bilaspur District
Sl. Activity Status No
1 24x7 PHCs Total 24x7 PHC 18 and PHC are functioning on 24x7 basis is 10
ASHA 3365 sanctioned, 3365 are selected and working and have been 2 ASHA trained, 175 Mitanin required training of Vth module and 395 required 6th and 7th module training .
Functioning as 3 1 DH and 1 CHC out of 8 CHC labelled as FRU is functioning as FRUs. FRUs
Rogi Kalyan 4 64 facilities (1 DH, 8 CHCs, 55 PHCs & have been registered with RKS. Samitis (RKS)
Village Health Sanitation & 5 Nutrition Out of 914 Villages , 907 Villages have constituted VHSNCs. Committees (VHSNCs)
6 MMUs 1 MMUs operational in this District in urban Bilaspur. ERS (108-type) 7 16 GVK (108-type) vehicles are operational and functional
Basic rd 8 Recently 20 Janani Express (104) type vehicles are operational. From 23 Ambulances August 2013 9 Infrastructure Sr.N Name of No of Works in Works in Not Page 5 Strengthening o works works complete progress Started (till April 2013) sancti d oned 1 DH 0 0 0 0
2 MCH 3 0 0 3 Wing 4 CHC 0 0 0 0
6 PHC 0 0 0 0
8 SHC 19 10 9 0
Total 22 10 9 31
Civil work and Sick New Born Care unit (SNCU) electrical work New Born Care completed Units Sanctioned 2 10 New Born Stabilization Unit (NBSU) established Functional 2 Sanctioned 35 New Born Care Corner (NBCC) Functional 16
Page 6 SSttaattee RReevviieeww MMiissssiioonn
(Supportive Super vision)
PRIMARY HEALTH CENTRE, TENGANMAR
DISTRICT BILASPUR
Page 7 Detail observations and area of improvement
1. Approach and accessibility: i. The Primary Health Centre is connected through all weather road and is well connected and easily approachable from bus stand. ii. The fencing of Primary Health Centre is not present. iii. The Primary Health Centre does not have an identified parking space. iv. Proper signage for easy identification of Primary Health Centre from a distance has not been made available.
2. Security services: Security services in the Primary Health Centre is not available;
3. Entrance:
i. The Primary Health Centre has one entrance at the front side. ii. Entrances to the Primary Health Centre is disable friendly with provision of ramp for easy access to wheel chairs, stretchers and ambulances but no hand rail is present.
4. Waiting area:
i. The entrance of the Primary Health Centre is followed by a small waiting area with adequate sitting arrangement . ii. The waiting area is poorly equipped. Wheel chairs and stretchers are not available
near the entrance. iii. Necessary signage related to direction of rooms national programmes, Citizen Charter, various services offered, rate lists, available human resource and complaint box are available in the OPD area iv. There is no Provision of separate toilets for males and females. v. Provision of drinking water is not available. Page 8
5. Registration counter: i. The Hospital has a common registration and Drug Dispensing Counter ii. The registration process is manual and pre printed format of OPD receipt is used. iii. The data of patients is properly maintained in the form of a register. iv. S.No, name, age, address, gender, caste BPL/APL, complaint and fee taken. v. The rate chart is displayed for various services provided.
6. Consultation rooms: i. Two Consultation room are available. One is for the Medical officer and other is for the RMA. ii. The rooms were well ventilated with proper provisions of sitting, and wash areas for Doctors. iii. Examination table with steps and screen were present to facilitate privacy of patient. iv. Basic Essential equipments like, adult weighing machine, BP apparatus, stethoscope and specialty wise were present.
v. The Primary Health Centre lacked running water facility. vi. Requisition slips for drug prescription was maintained. vii. The records of patient examination are not being maintained by the Medical officer.The RMA records wer found to be complete and updated.
Page 9
7. Injection room i. The injection room is available next to the Drug dispensary. ii. Emergency drug tray is not maintained, Needle Cutter present and was not in working condition iii. Proper infection control practices were not being followed, practices in relation to biomedical waste needs improvement. iv. Provisions for Privacy of patients with the help of movable screen not available.
8. Drug Dispensary i. The Primary Health Centre has a Single window dispensary. ii. Registers are poorly maintained with daily entry not being done in stock register. iii. Medicines record is not updated as expired medicines were found. iv. List of medicines available with expiry date and quantity was not being maintained
9. Pathology Laboratory: i. Is not functional and is operational in camp mode. 10. In patient Department i. The Primary Health Centre has a Two Bed Ward.. ii. Condition of beds was satisfactory. iii. Bed site lockers, IV stand and stools for attendants not present iv. Nurses station with emergency equipments and instruments like, emergency drug tray, oxygen cylinder, basic resuscitation kits is not present v. Needle cutter not present
Page 10
11. Labor Room i. Labor table with steps is present. ii. Macintosh was present but Kelyes pad was not available iii. All the basic equipments required with various trays like , MVA tray, Emergency medicine tray, Epistomy tray, delivery tray, baby tray were not present iv. Running tap water with provision of hot water was not present. v. The Attached toilet was found to be present in a very poor condition. vi. Suction machine was not functional.
NBCC(New born care corner)
i. NBCC was present present within the Labor room ii. The NBCC was present was found to be non functional.
12. Waste Disposal and Infection control Practices: i. The overall waste disposal practices in the facility were not satisfactory, Application for authorization is in progress ii. Proper segregation was not followed. Colour coded bins are available but not in use. iii. Deep pit and sharp pit for Disposal of waste were not constructed and were not used for disposal of anatomical and sharp waste. 13. Store The Hospital has a well organized store. The Pharmacist is well trained and all the records are properly maintained.
Page 11 Graphical Analysis
17.78 Infrastructure for ANC, Natal and PNC care 100.00 0.00 Knowledge & Skills Consumables and supplies 68.75 80.00
60.00
40.00 Maintenance of critical equipment Reporting 0.00 and infrastructure 20.00 50.00
0.00
Record & Maintenance Anti natal care services 10.34 20.00
Bio-Medical Waste Management Delivery or Natal Care Records 12.70
33.33 Post natal care
17.14
Page 12 ANC, Natal and PNC care- a. Running water and wash basin not available. b. Light on examination table is not sufficient. In delivery room light was opposite direction of labour table. c. SOPs not displayed in the labor room. d. NBCC was found non functional in the Labor room e. The Attached toilet was no running water found to be present in a very poor condition. f. Suction machine was not functional. g. All the basic equipments required with various trays like , MVA tray, Emergency medicine tray, Epistomy tray, delivery tray, baby tray were not present h. Nurses station with emergency equipments and instruments like, emergency drug tray, oxygen cylinder, basic resuscitation kits is not present. i. No. of deliveries declined sharply due to ANM has been transferred from PHC.
2. Consumables and supplies - a. Stocks of medicine supplies are sufficient. b. Daily entry not being done in stock register. c. Medicines record is not updated as several expired medicines were found. d. Despite availability of Iron syrup costly branded Iron syrup procured from market.
3. Maintenance of critical equipment and infrastructure a. Baby wormer and Suction machine not in functioning condition. b. Water purifier purchased and stored in almira because running water not available in the PHC.
4. Bio-Medical Waste Management a. Improper disposal system b. Deep pits and sharp pits are not constructed, c. Proper posters are not available. d. Color coded bins are not available. e. Disinfection through 1 % sodium chloride is not being practiced.
Page 13 f. PPEs used by the staff is not satisfactory.
5. Record & Maintenance and Reporting- a. New delivery not filled completely. Immunization, JSY payment, referral and discharge time has not been entering by in charge sister. b. OPD register has not proper information. c. Partograph not maintain . d. Validation of HMIS and E-mahatary report not being done by any one. e. ANM register not verified by supervisor or sector doctor. 6. Knowledge & Skills a. Trained staff not practices as use of partograph and complication management. 7. Other key Observations a. The waiting area is poorly equipped equipped. Wheel chairs and stretchers are not available near the entrance and is overcrowded as two water coolers have been kept.
Other Key recommendations
1. The BPM should prepare a flow chart of the center and identify patient contact point and strengthen each point, data recording, patient handling, and display of relevant IEC materials, inventory management and recording, patient over all experience. 2. The center should start functioning more as Comprehensive Health Care Services 3. To utilize the infrastructure and human resources for maximum output by least interventions, by BMO and BPM with clear definition of jobs. 4. keeping in proper formats, inventory management, follow infection control protocol, waste management require intervention
Page 14 5. The DPM should give visit to such centers and support to the BPM, BMO and chalk out plan to strengthen the hospitals. He /She should not wait for the letters/ guideline from state authority. 6. The CMHO should give a timeframe within which the DPM should be able the rectify the gaps .
7. The center should hold regular meeting of the Executive Committee of Jeevan Deep Samiti (which is not been held) and make plan for effective utilization of the fund. And avoid wasting the fund in purchasing
items of personal comfort, HR etc.
Page 15 SSttaattee RReevviieeww MMiissssiioonn
(Supportive Super vision )
PRIMARY HEALTH CENTRE , SIPAT
Page 16 Detail observations and area of improvement
14. Approach and accessibility: v. The Primary Health Centre is connected through all weather road and is well connected and easily approachable from bus stand. vi. The Primary Health Centre is surrounded by brick wall and wide gate leading to the main entrance of the Primary Health Centre. vii. The Primary Health Centre does not have an identified parking space. viii. Proper signage for easy identification of Primary Health Centre from a distance has not been made available.
15. Security services: Security services in the Primary Health Centre is not available;
16. Entrance:
iii. The Primary Health Centre has one entrances at the front side. iv. Entrances to the Primary Health Centre is disable friendly with provision of ramp for easy access to wheel chairs, stretchers and ambulances but no hand rail is present.
Figure 1:Main enterance to PHC Sipat
17. Waiting area: vi. The entrance of the Primary Health Centre is followed by a small waiting area with inadequate sitting arrangement. vii. The waiting area is poorly equipped equipped. Wheel chairs and stretchers are not available near the entrance and is overcrowded as two water coolers have been kept. viii. Necessary signage related to direction of rooms national programmes, Citizen Charter, various services offered, rate lists, available human resource and complaint box are not available in the OPD area
Page 17 ix. There is no Provision of separate toilets for males and females. x. Provision of drinking water is not available. 18. Registration counter: vi. The Hospital has a common registration and Drug Dispensing Counter vii. The registration process is manual and pre printed format of OPD receipt is used. viii. The data of patients is Poorly maintained in the form of a register. ix. S.no, name, age, address, gender, caste BPL/APL, complaint and fee taken. x. The rate chart is not Displayed for various services provided.
19. Consultation rooms: viii. Two Consultation room are available. One is for the Medical officer and other is for the RMA. ix. The rooms were well ventilated with proper provisions of sitting, and wash areas for Doctors. x. Examination table with steps and screen were present to facilitate privacy of patient. xi. Basic Essential equipments like, adult weighing machine, BP apparatus, stethoscope and specialty wise were present.
Page 18
xii. The Primary Health Centre lacked running water facility. \ xiii. Requisition slips for drug prescription was maintained. xiv. The records of patient examination are not being maintained by the Medical officer.The RMA records wer found to be complete and updated. 20. Injection room v. The injection room is available next to the Drug dispensary. . vi. Emergency drug tray is not maintained,.Needle Cutter present and was not in working condition vii. Proper infection control practices were not being followed, practices in relation to biomedical waste needs improvement. viii. Provisions for Privacy of patients with the help of movable screenis not available. ix. Expenditure Registers were properly maintained 21. Drug Dispensary v. The Primary Health Centre has a Single window dispensary . vi. Registers are poorly maintained with daily entry not being done in stock register. vii. Medicines record is not updated as several expired medicines were found. viii. List of medicines available with expiry date and quantity was not being maintained ix. Timings of the dispensary and list of drugs available were not displayed
Page 19
22. Pathology Laboratory: ii. Room no and Timings is not being displayed. A list of tests available and Fee charged separately outside the lab is not displayed iii. The lab offers services of basic routine test iv. The lab is well maintained lab with proper infection control practices not in place. Refrigerator is present for storage of reagents present but temperature in the lab is not maintained.. v. Printed formats for reporting with normal value range were present vi. Separate registers printed for various tests done present vii. Biomedical waste management was found satisfactory, with adequate bins and IEC. viii. PPEs used by staff was unsatisfactory
23. In patient Department vi. The Hospital Does not have any ward and patient beds are kept in the corridor. vii. Condition of beds was satisfactory , but are kept in an open space viii. Bed site lockers, IV stand and stools for attendants not present ix. Nurses station with emergency equipments and instruments like, emergency drug tray, oxygen cylinder, basic resuscitation kits is not present x. Needle cutter not present
Page 20 24. Labor Room vii. Labor table with steps is present. viii. Macintosh was present but Kelyes pad was not available ix. All the basic equipments required with various trays like , MVA tray, Emergency medicine tray, Epistomy tray, delivery tray, baby tray were not present x. Running tap water with provision of hot water was not present. xi. The Attached toilet was found to be present in a very poor condition. xii. Suction machine was not functional.
NBCC(New born care corner)
iii. NBCC was present not present within the Labor room iv. The NBCC was present in the consultation room and was found to be non functional.
25. Waste Disposal and Infection control Practices: iv. The overall waste disposal practices in the facility were not satisfactory, Application for authorization is in progress v. Proper segregation was not followed. This might be due to non availability of proper color coded bins in the facility. vi. Deep pit and sharp pit for Disposal of waste were not constructed and were not used for disposal of anatomical and sharp waste. 26. Addition Space in the Hospital:
There is an additional; space in the Hospital which is newly constructed and is being utilized only for camp purpose .The Additional Building has : i. Operation Theatre ii. Wards iii. Waiting area.
Page 21 iv.
Page 22 Graphical Analysis
31.11
Infrastructure for ANC, Natal and PNC care 100.00
Knowledge & Skills Consumables and supplies 57.14 80.00 70.31
60.00
40.00 Maintenance of critical equipment and Reporting 42.86 infrastructure 20.00 33.33 0.00
Record & Maintenance Anti natal care services
20.00 22.41
Bio-Medical Waste Management Delivery or Natal Care Records 0.00
Post natal care 8.73 Page 23 11.43 8. ANC, Natal and PNC care- a. Proper privacy not maintain during ANC checkup. b. Running water and wash basin not available. c. Light on examination table is not sufficient. d. Hygiene in delivery room and word not maintain. e. SOPs not displayed in the labor room. f. NBCC was present not present within the Labor room g. The Attached toilet was found to be present in a very poor condition. h. Suction machine was not functional. i. All the basic equipments required with various trays like , MVA tray, Emergency medicine tray, Epistomy tray, delivery tray, baby tray were not present j. Nurses station with emergency equipments and instruments like, emergency drug tray, oxygen cylinder, basic resuscitation kits is not present k. The Hospital Does not have any ward and patient beds are kept in the corridor. Bed site lockers, IV stand and stools for attendants not present
9. Consumables and supplies - a. Stocks of medicine supplies are sufficient. b. Stock book not updated. c. Registers are poorly maintained with daily entry not being done in stock register. d. Medicines record is not updated as several expired medicines were found.
10. Maintenance of critical equipment and infrastructure a. Baby wormer and Suction machine not in functioning condition.
11. Bio-Medical Waste Management a. Improper disposal system b. Deep pits and sharp pits are not constructed, c. Proper posters are not available in the departments.
Page 24 d. Colour coded bins are not available . e. Disinfection through 1 % sodium chloride is not being practiced. f. PPEs used by the staff are not satisfactory.
12. Record & Maintenance and Reporting- a. New delivery not filled completely. Immunization, JSY payment, referral and discharge time has not been entering by in charge sister. b. OPD register has not proper information. c. Partograph not maintain. d. Validation of HMIS and E-mahatary report not being done by any one. e. ANM register not verified by supervisor or sector doctor. 13. Knowledge & Skills a. Trained staff not practices as use of partograph and complication management. 14. Other key Observations a. The waiting area is poorly equipped. Wheel chairs and stretchers are not available near the entrance and is overcrowded as two water coolers have been kept.
Other Key recommendations
1. The BPM should prepare a flow chart of the center and identify patient contact point and strengthen each point, data recording, patient handling, and display of relevant IEC materials, inventory management and recording, patient over all experience. 2. The center should start functioning more as Comprehensive Health Care Services 3. To utilize the infrastructure and human resources for maximum output by least interventions, by BMO and BPM with clear definition of jobs.
Page 25 4. keeping in proper formats, inventory management, follow infection control protocol, waste management require intervention 5. The DPM should give visit to such centers and support to the BPM, BMO and chalk out plan to strengthen the hospitals. He /She should not wait for the letters/ guideline from state authority.
6. The CMHO should give a timeframe within which the DPM should be able the rectify the gaps 7. The center should hold regular meeting of the Executive Committee of Jeevan Deep Samiti (which is not been held) and make plan for effective utilization of the fund. And avoid wasting the fund in purchasing items of personal comfort, HR etc.
Page 26 SSttaattee RReevviieeww MMiissssiioonn
(Supportive Super vision)
COMMUNITY HEALTH CENTER, BILHA
Page 27 BILHA
Bilha CHC has 9 Primary health facility (PHC) and 54 SHCs in its region. Out of the 9 PHCs, 4 function in government buildings whereas the other 5 function from non-government building. Similarly there are 54 SHCs out of which 7 function in government buildings and 47 in non-government buildings. BLOCK MAP OF BILHA
Page 28
COMMUNITY HEALTH CEN TRE BILHA, B I L A S P U R
The Community Health Centre Bilha initially started as primary health center and was transformed to community health center [CHC] in 1995. The Community Health Centre Bilha serves population of Bilha block [92 villages] covering a population of 3, 41,260. Bilha CHC is the first block level FRU in the state, complete in all respects. BILHA CHC has a full-fledged OT, Neonatal stabilization unit, a blood storage center and referral transport service.
The Community Health Centre Bilha delivers patient care through its clinical, supportive and utility services. As shown below core services –OPD, IPD, emergency services are in house. Community Health Centre Bilha does not have any dietary services and the laundry service of the Community Health Centre Bilha is outsourced.
The Community Health Centre Bilha has following services Outpatient services Specialist services o SURGERY o OBS and Gynecology o PAEDIATRICS. Inpatient services Emergency services Ambulance services Page 29 Lab services Referral services
CHC - LAYOUT
CHC, Bilha developed from a Primary health Centre to a community health centre which led to the addition of new services and infrastructure. The Community Health Centre Bilha is single storied with separate blocks or buildings which houses different sections and services in the Community Health Centre Bilha.
The Out-Patient Department block houses the registration counter and OPD clinics. The blood storage unit and dressing room are also included in the OPD Block. The digital X-Ray and Neonatal stabilization units serve together in a separate building while the DOTS center and ICTC serve in another.
The IPD block is a stretch having a 12 bedded ward with a Vaccination Room and Stores. The paying ward and the maternity ward are closely linked together as a single unit with the labour room.
The Operation Theatre is located in a separate building. The Block Medical Officer’s office is also housed in the same building. The building also has the laboratory and X-Ray. There is a separate Admin Block for the administration activities for the Community Health Centre Bilha.
The Community Health Centre Bilha has got the following departments or sections:
Registration counter OPD section Emergency section Radiology department
Page 30 Laboratory Stores Mortuary Blood storage unit DOTS centre ICTC centre Vaccination room IPD Dressing room / Plaster room Labour room Drug dispensing counter Neonatal stabilization unit The following picture gives the layout of the CHC Bilha.:
Figure 2: Layout of CHC, BHILLA Department wise Observations
Page 31 27. Approach and accessibility: i. The Community Health Centre Bilha is situated on Bilaspur road and is well connected and easily approachable from bus stand. ii. The Community Health Centre Bilha does not have a boundary wall. iii. The Community Health Centre Bilha does not have an identified parking space. iv. Proper signage for easy identification of Community Health Centre Bilha from a distance is not available.
28. Security services: Security services in the Community Health Centre Bilha were not available; services in the night are being made available in the Community Health Centre Bilha through JDS.
29. Entrance:
i. The Community Health Centre Bilha has two entrances . v. All entrances to the Community Health Centre Bilha are disable friendly with provision of ramps for easy access to wheel chairs, stretchers and ambulances. vi. The main entrance has adequate space for simultaneous movement of 2 stretchers.
30. Waiting area: i. The entrance of the Community Health Centre Bilha is followed by a large waiting area with adequate sitting arrangement. New benches for sitting have been added. ii. The waiting area is not equipped with Wheel chairs and stretchers
Page 32 iii. Necessary signage related to direction of rooms national programmes, Citizen Charter, various services offered, rate lists, available human resource and complaint box are not displayed in the OPD area. iv. Drinking water facility is available in the waiting area.
31. Mitanin Help Desk: i. Separate demarcated area has been identified for the mitanin ii. The mitanin help desk is placed at area where it can be easily located iii. The register maintained by mitanin was found proper and complete.
32. Registration counter: i. The Hospital has a common registration and Drug Dispensing Counter ii. The registration process is manual and pre printed format of OPD receipt is used. iii. The data of patients is properly maintained in the form of a register. iv. S.No, name, age, address, gender, caste BPL/APL, complaint and fee taken. v. The rate chart is Displayed for various services provided.
Page 33
33. Consultation rooms: i. Specialty wise separate consultation rooms with numbering and adequate sitting arrangement outside the room for patients was present. ii. The rooms were well ventilated with proper provisions of sitting, and wash areas for Doctors. iii. Examination table with steps and screen were present to facilitate privacy of patient. iv. Basic Essential equipments like, adult weighing machine, BP apparatus, stethoscope and specialty wise were present.
v. Gaps in proper hand washing facilities were found. Provision of overhead tank was available for OT and LR,
Page 34 vi. Requisition slips for drug prescription was maintained. Suggestions regarding different printed requisition forms for investigation and to be made available were given. 34. Injection room i. The injection room is available next to the In Patient Department. ii. The nurse station is equipped with necessary consumable and Disposables. iii. Emergency drug tray is maintained, list of medicines in the tray needs to be mentioned. iv. Needle Cutter present and was in working condition v. Proper infection control practices were not being followed, practices in relation to biomedical waste needs improvement. vi. Provisions for Privacy of patients with the help of movable screen could be made. vii. Expenditure Registers were properly maintained
35. Drug Dispensary i. The Community Health Centre Bilha has a Single window dispensary and the services of pharmacist present ii. Registers are well maintained with daily entry in stock register. iii. List of medicines available with expiry date and quantity was maintained iv. Timings of the dispensary and list of drugs available is displayed
36. Pathology Laboratory: i. Room no and Timings is being displayed. A list of tests available and Fee charged separately outside the lab needs to be displayed ii. The lab offers services of basic routine test iii. The lab is well maintained lab with proper infection control practices in place. iv. Refrigerator is present for storage of reagents present. It was suggested to maintain a temperature chart for easy monitoring. v. Printed formats for reporting with normal value range was not present vi. Separate registers printed for various tests done present Page 35 vii. Biomedical waste management was found satisfactory, with adequate bins and IEC. viii. PPEs used by staff was satisfactory.
37. Radiology: X-ray i. Separate x-ray room and dark room were present ii. Safety equipments like screen and lead aprons present for the employees. TLD batches is being used. iii. Proper signage were found. Caution signage for pregnant lady needs displayed iv. The windows of the X-ray Room need closure.
38. In patient Department i. The Community Health Centre Bilha has two general wards and two maternity wards and one casualty ward. ii. Condition of beds were not satisfactory , beds were not properly arranged without adequate space between the beds, iii. Bed site lockers, IV stand and stools for attendants not present and are needed to be procured. iv. Nurses station with emergency equipments and instruments like, emergency drug tray, oxygen cylinder, basic resuscitation kits is present v. Needle cutter present vi. Color coded bins for proper segregation of waste were not present and needed procurement.
Page 36
39. Operation Theater: i. The Community Health Centre Bilha has a well constructed Operation theatre ii. The Community Health Centre Bilha offers services of CTT and minor surgeries. Anesthetist present on call iii. Proper Zoning in OT not present. Maintenance OT was satisfactory, tiling on both floors and walls was done with marbles. iv. OT tables were painted and well maintained.
v. Clean slippers, drug and instrument trolley, oxygen cylinders, nitrous oxide cylinders, suction machine are present. vi. Pre printed Consent forms taken before surgery. Records and registers were found complete. vii. Infection control practices were satisfactory. Periodic fumigation was
done. Register for fumigation was suggested.
Page 37 viii. Provision for Signalac tape and swab culture of the OT were suggested ix. BMW bins for segregation were present, segregation was not found up to the mark.
40. Labor Room xiii. Labor table with steps xiv. Curtain between the labor table is not present. xv. Macintosh was available xvi. Kelyes pad was not available xvii. All the basic equipments required with various trays like , MVA tray, Emergency medicine tray, Epistomy tray, delivery tray, baby tray were not present xviii. Running tap water with provision of hot water was present xix. Attached toilet was present however proper maintenance was needed
NBCC(New born care corner)
v. NBCC was present within the Labor room vi. The NBCC was well equipped with the resuscitation kit vii. Radiant warmer was not available, bulbs were attached as an alternate provision
Page 38
41. Waste Disposal and Infection control Practices: i. The overall waste disposal practices in the facility were not satisfactory, Application for authorization is in progress ii. Proper segregation was not followed. This might be due to non availability of proper color coded bins in the facility. iii. Deep pit and sharp pit for Disposal of waste were constructed and were used for disposal of anatomical and sharp waste.
iv. The plastic waste was currently being burned; it was suggested to handover the plastic waste to the municipal bodies collecting waste after proper disinfection and mutilation of the waste generated. v. IEC and posters were available in the Community Health Centre Bilha and were displayed only in few departments. It was suggested to paste posters in all the departments available with special focus on the high risk areas like Lab, Injection room, OT, Labor room and nurses’ stations in IPD and casualty wards.
Page 39 Graphical Analysis
Bilha( Bilaspur)
42.22 Infrastructure for ANC, Natal and PNC care 100.00
Knowledge & Skills Consumables and supplies 67.19 85.71 80.00
60.00
40.00 Maintenance of critical equipment and Reporting 42.86 infrastructure 20.00 58.33
0.00
Record & Maintenance Anti natal care services27.59 46.67
Bio-Medical Waste Management Delivery or Natal Care Records 14.29 16.67 Post natal care 68.57
Page 40 15. ANC, Natal and PNC care- a. Availability of infrastructure and care for ANC, Natal and PNC is average in the facility. b. Essential and specialty wise equipments and instruments were not available in the examination rooms. c. Proper privacy not maintain during ANC checkup. d. Running water and wash basin not available. e. Light on examination table is not sufficient. f. Aseptic Hygiene in delivery room and ward not maintain. g. SOPs not displayed in the labor room. h. The essential Tray for the Labor room was not present.
16. Consumables and supplies - a. Stocks of medicine are sufficient. b. Stock book not updated. Store as whole un -organised
17. Maintenance of critical equipment and infrastructure a. Baby wormer of NBSU non functional b. Water cooler in critical reparable condition and water filter is non functional. c. Some equipment in the laboratory are not maintained.
18. Bio-Medical Waste Management a. Improper Waste disposal system b. Proper SOPs are not available. c. Color coded bins not available. d. Disinfection through 1 % sodium chloride is not being practiced.
19. Record & Maintenance and Reporting- a. New delivery register not filled completely. Immunization, JSY payment, referral and discharge time has not been entering by in charge sister.
Page 41 b. Data definition not clears to BADA and BPM. c. OPD register has not proper information. d. Patrography not maintained e. Validation of HMIS and E-mahatari report not being done by any one. f. ANM register not verified by supervisor or sector doctor. 20. Knowledge & Skills a. SBA trained staff nurse but not following the protocol of delivery room. 21. Other key Observations a. This center is grossly underutilized. b. Blood storage unit non functional due to unavailability of generator and AC. c. Follow up MCTS entry has not been done from block level.
Other Key recommendations
8. The BPM and the staff required hand holding support for DPM at the initial period. The BPM should prepare a flow chart of the center and identify patient contact point and strengthen each point, data recording, patient handling, and display of relevant IEC materials, inventory management and recording, patient over all experience. The BPM should conduct exist interview of few patients on regular basis and find out the gaps in quality of services as per their perspective. And with BMO should find out resource to plug in those gaps.
Page 42 9. Effective use of the fund available under Jeevan Deep Samiti after prioritizing the demands. Should avoid use of fund for which regular sources are available. 10. The center should start functioning more as Comprehensive Health Care Services than a level 2 RCH center. 11. District level supervision and Intervention required for record keeping in proper formats, inventory management, follow infection control protocol, waste management . 12. The DPM should visit to such centers and spend good time with the BPM , BMO and chalk out plan to strengthen the hospitals. He /She should not wait for the letters/ guideline from state authority. The CMHO should give a timeframe within which the DPM should be able the rectify the mistakes and fill the identified gaps. 13. The center should hold regular meeting of the Executive Committee of Jeevan Deep Samiti (which is not been held) and make plan for effective utilization of the fund. And avoid wasting the fund in purchasing items of personal comfort, HR etc
Page 43 SSttaattee RReevviieeww MMiissssiioonn
(Supportive Super vision )
COMMUNITY HEALTH CENTER,Masturi
Page 44 Summary Report of facility
22. ANC, Natal and PNC care- i. The B.P. machine and the Weighing scale is not being in a proper condition ii. Signage in the Consultation room not mentioned. iii. The labor tables are covered with Macintosh but it was found soaked with dirty and old blood. iv. The baby warmer of the labor room is not functional. The leads to be attached to the skin of baby was found to be broken. v. The labor room does not have running water facility. vi. For separating two Labor Table mobile screen is not present. vii. The labor room does not maintains essential Trays (Emergency medicine Tray, Medicine Tray, Delivery Tray, Baby Tray, MVA, Ambu bag kit pediatric and adult). viii. There is no Calleys pad available on the labor table ix. Essential and specialty wise equipments and instruments were not available in the examination rooms. x. Proper privacy not maintain during ANC checkup. xi. Light on examination table is not sufficient. xii. Aseptic Hygiene in delivery room and word not maintain. xiii. SOPs not displayed in the labor room.
23. Consumables and supplies - i. Stocks of medicine supplies are sufficient. ii. Stock book not updated completely. Totally Miss-managed iii. Issue system not in place iv. There is no system of monitoring of near expiry thence huge amount of near expiry drugs was found.
24. Maintenance of critical equipment and infrastructure i. Baby wormer not in functioning condition. ii. Some equipment in the OT and laboratory are not maintained.
25. Bio-Medical Waste Management i. There is no provision for segregation of Bio medical Waste. Staff has not been trained for segregation and handling of Bio medical waste ii. Designated Colour coded bins are not present. iii. For the Disposal of Sharp waste, sharp pit is not present . iv. Deep pit is not available ,the waste is handed over to the Muncipal Corporation v. Proper posters are not available in the departments. vi. Disinfection through 1 % sodium chloride is not being practiced. Page 45
26. Record & Maintenance and Reporting- i. New delivery register not filled completely. Immunization, JSY payment, referral and discharge time has not been entering by in charge sister. ii. OPD register has not proper information. iii. Partograph not maintained. iv. Validation of HMIS and E-mahatary report not being done by any one. v. ANM register not verified by supervisor or sector doctor as per data centre visit. 27. Knowledge & Skills i. Trained staff not being practice partograph and complication management. ii. Requires nominating for IMNCI, IUCD, and SBA trainings. 28. Other key Observations i. The hospital waiting area does not have drinking water facility and are patients are forced to bring their own water or buy from the shop outside. ii. The waiting area does not have sufficient seating area for the Patients and attendants. iii. The medicines were placed in a haphazard manner.The uniformity of maintain ace of stock is not followed. iv. There is no system of maintenance of daily records of medicine distribution. v. The Duty Roster of the Doctors is not updated. vi. The Hospital Does not have a designated Mitanin Help Desk.
Page 46 Detail observations and area of improvement
The CHC Masturi is a 30 bedded facility which caters to almost to a population of 30,000.The CHC is situated at a Distance of 17 Kilometer and is well connected with an all weather road. The hospital is built upon on an area of 2500 Sq.ft. The nearest railway station to the Hospital is Bilaspur and bus stand is at a distance of 1 Km.
The Hospital has its own boundary wall. The CHC building is divided into four Blocks
1. O.P.D.Block 2. I.P.D.Block 3. Lab Investigation 4. Anti Natal care Block
The Hospital provides services in following facilities: General Medicine. Obstetrics and Gynecology Pediatrics Surgery
Page 47
1. Layout of the Hospital: 1. O.P.D.Block: 1. Mitanin Help Desk 2. Patient registration Counter 3. Drug Dispensing Counter 4. Doctors Consultation room 5. X –Ray 6. Dressing Room 7. Immunization
2. In Patient Department Block 1. Operation Theatre 2. Nursing Station 3. General Ward 4. Female Ward 5. Labor Ward 6. Store
3.Anti Natal Care Block
1. Labor Room 2. P.N.C.Room 3. New Born Baby Corner Page 48 4. Nursing Station
4.Lab Investigation
1. Lab Investigation 2. ICTC
1. Mitanin Help Desk: The Hospital Does not have a designated Mitanin Help Desk. Mitanin was not available on the Desk during the O.P.D.visiting hours to provides the requisite information to the Patients. IEC for Mitanin help Desk was not observed. It was only written as Mitanin Counter. The Standard procedures have not been followed.
2. Hospital registration Counter and Drug Dispensing Counter :The Hospital has a common Registration and a drug Dispensing Counter
Page 49
Registration Counter
1. The Hospital Registration counter does not provide requisite information to the Patients 2. The Duty Roster of the Doctors is not updated. 3. The Information regarding availability of medicine is not updated on daily basis. 4. The rate chart for the various services are not Displayed. 5. The List of available services is not displayed. 6. The Registration counter does not maintain a uniform pattern of maintainace of records and keeps on changing as per the desire of the Pharmacist
Drug Dispensing Counter:
1. There is no system of maintenance of daily records of medicine distribution. 2. The Drug dispensing counter does not follow the mechanism of near expiry drug list. On inspection huge number of expired drug were found. 3. The medicines were placed in a haphazard manner.The uniformity of maintainace of stock is not followed. 4. No system of FIFO is followed. Page 50
Patient Waiting Area:
The waiting area does not have sufficient seating area for the Patients and attendents.IEC material for providing information to the patients regarding Opening and Closing time and various National Programmes for which services are not displayed in the Hospital.
The hospital waiting area does not have drinking water facility and are patients are forced to bring their own water or buy from the shop outside the Community Health Centre.
Consultation Room:
There are four consultation rooms in the O.P.D. The B.P. machine and the Weighing scale is not being calibrated in monthly basis. The records of the Consultants were found to be incomplete.
Page 51 Gap Observed: In the Consultation room the name of the Specialist/Medical officer is not mentioned.
Prescription pattern by RMA is not proper ( Multiple antibiotic of same group, antiallergic)
Laboratory Services:
The laboratory services provides hematological investigations. Microbiology or Biochemistry test are not being conducted by the lab. .
1. The post of pathologist is vacant 2. The pathological lab is functional during OPD hours and the timings of the Lab are displayed. One Lab Technician is available on call basis. 3. The charges for various tests are displayed near the O.P.D. 4. Reagent register with quantity of date of expiry is not mentioned. 5. Hand washing facility is not available. 6. The Records of the Test conducted is well documented and is traceable
Page 52
1. Duty chart of the Lab Technician is not Displayed. 2. PPEs are not used by the Staff. 3. Immunization schedule of HR is not present. 4. Calibration of the Equipment is not being conducted. 5. Temperature of the Refrigerator for keeping reagent is not maintained in the Pathological Lab. 6. In the Lab there is no evidence of Bio Medical Waste Management.
Operation Theatre:
The Operation Theatre does not follow the principal of Zoning. The operation theatre has a designated Pre-Operative area and Operation Theatre.The hospital provides LTT, CTT and NSV services to the clients.
Gaps Observed: 1. Fumigation Records are not maintained 2. Designated scub area is not present 3. Door of the O.T.is single leaf type 4. Power backup with battery inverter is not present. 5. Emergency medicine tray is not present. 6. Scrub area does not have elbow operated taps. 7. Hand Washing instructions not displayed.
Page 53
Theatre Sterile Supply Department:
The Hospital does not has a TSSU in the Operation Theatre. One functional electric Autoclave is present in the TSSU. The O.T.attendent is well aware with the sterilization process.
Gaps observed: 1. Date of sterilization is not being put on drums. 2. Register for Autoclave of Drums is not being maintained. 3. Standard Operating Procedure for Sterilization is not being displayed. 4. Signolac tape is not used for checking whether the Consumables are sterilized or not.
Labor Room: The labor room of the hospital has two Labor Table. The labor room is poorly equipped. The New Born baby is not present in the labor room.
1. The entrance to the labor room is covered with curtain. 2. The labor tables are covered with Macintosh but it was found soaked with blood. 3. The baby warmer of the labor room is not functional.The leads to be attached to the skin of baby was found to be broken. 4.The labor room does not have running water facility. 5.The IEC regarding complications during the Labor is not Displayed. 6. For separating two Labor Table mobile screen is not present. 7. The labor room does not maintains the following tray Emergency medicine Tray with emergency Drug List. Medicine Tray Delivery Tray Baby Tray MVA Ambu bag kit pediatric and adult There is no facility of warm water in the labor room. There is no provision of Air Conditioning in the labor room. There is no Callys pad available on the labor table.
Wards: The Hospital Comprises of three wards 1. General Ward 2. Female Ward
Page 54 3. ANC Ward.
1. Some of the Beds have been repaired and some of the Beds have been ordered for purchase.
2. Mattress of the existing beds are in good condition. 3. Linen of the wards is in good condition. 4. Stool for attendant is not present therefore attendants are forced to sit on patients bed. 5. Records were found to be complete and updated. 6. The three ft space between the beds is being maintained. Gaps Observed:
1. The Bed occupancy of the Hospital is very Low. 2. There are no I.V.stands available in the wards. 3. There are no curtains available on the windows. 4. Bed Side lockers are not present for all the beds 5. Emergency drug tray with emergency drug list is not present in the Nursing station of the Ward. 6. Oxygen cylinder is present and is being checked on regular basis 7. Patients are not being provided with discharge ticket on getting discharge from the hospital. 8. The bathrooms attached to the wards are in pathetic conditions. 9. Wrong information was found to be pasted in the wards.
Page 55
Bio Medical Waste management:
Gaps Observed: 1. There is no provision for segregation of Bio medical Waste. 2. Designated bins are not present. 3. For the Disposal of Sharp waste, sharp pit is not present . 4. Deep pit is not available the waste is handed over to the Muncipal Corporation. 5. Staff has not been trained for segregation and handling of Bio medical waste.
Stores:
Page 56
The Hosptal houses a huge store where huge amount of Drugs and consumables are kept.the System of Recording keeping is good but as the medicines are not distributed huge amount of medicines were found to be present. There is no system of monitoring of near expiry thence huge amount of near expiry drugs was found.
Security Services: The security services is not evident in the Hospital Premioses..
Housekeeping services: There are two workers who are posted on regular basis and four workers have been kept from Jeevan Deep Samiti to carry out the House keeping activity there is no system for monitoring of these workers.
Laundry Services:
Laundry services are being outsourced to a local washerman.
Dietary services: The Dietary services are out sourced and are not provided .
Page 57 Graphical Analysis
35.56 Infrastructure for ANC, Natal and PNC care 100.00
7.14 Knowledge & Skills Consumables and supplies 80.00 65.63
60.00
40.00 Maintenance of critical equipment and Reporting 28.57 infrastructure 20.00 33.33
0.00
20.00 Record & Maintenance Anti natal care services 24.14
Bio-Medical Waste Management Delivery or Natal Care Records 19.84 50.00 Post natal care 20.00
Page 58
Other Key recommendations 1. The BPM should prepare a flow chart of the center and identify patient contact point and strengthen each point, data recording, patient handling, and display of relevant IEC materials, inventory management and recording, patient over all experience. The BPM should conduct exist interview of few patients on regular basis and find out the gaps in quality of services as per their perspective. And with BMO should find out resource to plug in those gaps. 2. Effective use of the fund available under Jeevan Deep Samiti after prioritizing the demands. Should avoid use of fund for which regular sources are available. 3. The center should start functioning more as Comprehensive Health Care Services than a level 2 RCH center. 4. To achieve the efficiency of the structure outside interventions are least required, the staffs of the hospital especially the BMO and BPM is capable to do so, and only thing is require is the desire to do it. Intervention like record keeping in proper formats, inventory management, follow infection control protocol, waste management require intervention 5. The DPM should give visit to such centers and spend time with the BPM , BMO and chalk out plan to strengthen the hospitals. He /She should not wait for the letters/ guideline from state authority. The CMHO should give a timeframe within which the DPM should be able to rectify the mistakes and fill the gaps identified.
6. The center should hold regular meeting of the Executive Committee of Jeevan Deep Samiti (which is not been held) and make plan for effective utilization of the fund. And avoid wasting the fund in purchasing items of personal
comfort, HR etc.
Page 59
Page 60 SSttaattee RReevviieeww MMiissssiioonn
(Supportive Super vision )
SARDAR PATEL
DISTRICT HOSPITAL, BILASPUR
Detail observations and area of improvement
SARDAR PATEL DISTRICT HOSPITAL – AN INTRODUCTION
Sardar Patel District Hospital is the district hospital of Bilaspur situated near the central bus stand of Bilaspur. The hospital is a 100 bedded which provides all the essential preventive, curative and promotive and emergency services to the people of Bilaspur district.
The year 1956 marked the foundation of the Sardar Patel District Hospital of Bilaspur. The hospital was merged with the CIMS hospital of the city in the year 2001. In 2005 the hospital was re- established as a separate unit at Sarkhanda. The hospital was then running in the premises of the eye hospital of Sarkhanda. The new building for the hospital was inaugurated on 15th August 2008.
The hospital is independently functional with one main building and one Dharmasala which is under construction for the relatives of the patient.
The major catchment area of the hospital is the main city of Bilaspur and the district of Bilaspur. The hospital caters to a population of 23.4 lakhs. Being a government hospital the cost of treatment in the hospital is low which attracts a huge number of patients from the weaker section of the society. The hospital having all the facilities except for super specialiity services is able to take care and fulfill the health care needs of a large population of the area.
The hospital has sanctioned 100 bedded; the number of operational beds in the hospital is 141. With the introduction of 12 beds of Special Neo-Natal Care Unit (SNCU) and 30 beds of Sarkhanda Hospital the bed availability of the hospital would reach 183.
Page | 62
The distribution of the beds available in the hospital currently is as follows:
DEPARTMENT NO. OF BEDS
Paying ward 20
Medicine 22
Surgery 19
Orthopaedics 19
Paediatrics 9
Casualty 6
ICU 2
HDU 2
Obstretics and gynaecology 14
Preoperative 16
ANC 4
Isolation 8
Total number of beds 141
SERVICES AVAILABLE AT THE HOSPITAL
Sardar Patel District Hospital, Bilaspur is a combined hospital offering preventive, preventive and curative services to the community. The hospital is a general hospital and currently provides OPD services in General Medicine, Ob&G, Orthopedic, Pediatric, E.N.T., Ophthalmic and Dental. The hospital provides In-Patient (IP) services through a sanctioned bed-strength of 100 beds. The hospital provides surgical services also and has General, Eye, ENT, and Gynecological surgical wards to take care of the patients undergoing minor and major surgeries.
The hospital delivers patient care through its clinical, supportive and utility service areas. As shown below, both core services and support services are in-house, whereas utility services are both
Page | 63
in-house and outsourced. Dietary, security, housekeeping and laundry services are outsourced by the hospital.
Core Services In Patient Emergency Out Patient Services Services Services Intensive Care Unit General Medicine, Paediatiric, Obstetrics and Gyneacology, Orthopedic, Opthalmic, ENT, Dental, Tb and Chest ,psychiatry. Surgical Services:- Minor and Major procedures in General Surgical, Orthopedic, Eye, ENT Support Services Laboratory Radiology Services:- Clinical Immunization Pathology ICTC Pathology Family Planning Histopathology Central Medical Stores Serology Physiotherapy Microbiology BioChemistry CSSD Utility Services In House Outsourced Laundry Services Medical Record Security Services Medical Gases Housekeeping keeing and Dietary Services services / BMW Statistics
Following are the available facilities at different areas in the hospital.
1. OUT PATIENT DEPARTMENT: 2. The out-patient department of the hospital includes an 3. A MLC/General OPD for Patient Consultation 4. A Medicine Unit 5. A Surgery/Minor OT for injection and dressing 6. An Orthopaedics & physiotherapy 7. A Gynaecology room for Maternity consultation. 8. Paediatrics room 9. A Dental Clinic 10. An Opthalmic centre. 11. A TB and chest 12. A Psychiatry unit 13. INPATIENT DEPARTMENT: Page | 64
14. The IPD of the hospital renders the following services to the patients: 15. Surgery which includes Surgical Wards and Operation Theatre. 16. Orthopaedics 17. Medicine 18. Gynaecology and Obstretics 19. Pediatrics 20. Isolation wards 21. Swine flu ward
OTHER FACILITIES:
1. Intensive Care Unit 2. A Dialysis unit 3. Audiometry 4. Physiotherapy 5. SNCU 6. Vaccination room 7. Plaster room
DIAGNOSTICS SERVICES:
The table shown below explains the diagonistic services in the Hospital. The hospital provides laboratory, radiology and other diagonisitic services. Laboratory services include Bio-chemical tests like Haemetology, Microbiology, Serology and Bio-chemistry along with Stool examination, semen examination and Urine analysis. X-ray, USG, Mammography and BMD are available as a part of radiology services. Other than the above ECG, TMT, Long Function Test and Spirometry are included in the diagonistic service facilities in the hospital.
LABORATORY RADIOLOGY OTHERS
Haematology X-ray ECG
Microbiology USG TMT
Serology Mammography Lung Function test
Biochemistry BMD Spirometry
Stool examination
Semen examination
Urine analysis
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Approach and accessibility:
The District Hospital is well connected with all weather road and is situated on the heart of city near by bus stand.
Prominent signages both near the road and on the building of District Hospital facilitate the easy location and identification of the District Hospital from the main road. Entrance:
The entrances to the District Hospital have provision of ramp.
The entrances to the building have adequate space Waiting area:
The corridor leads into a huge waiting space with prominently displayed registration counter at the front.
Signages regarding regarding the national Programmes and other necessary information are well displayed.
The Waiting area has fixed chairs for seating people.
Registration counter:
Computerized registration Counter for male and female is Present.
On the registration counter prominent display of registration fee and timings and classification of different slips were Displayed
Computerized formats for OPD slip was used.
Mitanin Help Desk:
Mitanin Help Desk is present at the District Hospital Entrance, but not prominent display of Mitanin sitting place. Consultation rooms:
The rooms were prominent display of name, qualification of doctor.
The consultation rooms are well ventilated, clean and hygienic. Page | 66
Examination tables with screen and steps are present.
Hand washing facilities for the staff was not satisfactory.
Injection room and dressing room :
Injections are administered in the corridor without any precaution of safety majors.
The Emergency medicine tray is not being maintained.
The needle cutter was not available in the injection room/place.
Infection control practices were found unsatisfactory with unavailability of proper IEC and improper use of PPEs.
Daily injection stock registers were not maintained.
Drug dispensing counter:
The drug dispensing counter manned with a qualified pharmacist was present.
Timings for the opening and closing of dispensary are well displayed.
The Drug dispensing counter has a single window.
Daily consumption of drug list is being maintained well.
In patient Wards:
In the District Hospital all the 350 beds are functional. The Community Health Centre consists of three general ward one each for male and female and children.
The wards is attached with a nursing station
The condition of beds was average. The beds were properly arranged. Next to each beds attendants stool, IV stand and bed side lockers were present. Page | 67
Diet was provided to the patients. Quality of food was found satisfactory.
Waste management and infection control practices were found unsatisfactory. Operation Theater:
Running water facility is available in the operation Theatre
The necessary Equipment is available in the Operation Theatre.
Autoclave is available but not fuctioning properly.
Zoning of the Operation Theatre has been done.
Emergency Drug Tray is present.
On the Drum that is Sterlized, the Date of sterilization is present.
Labor room:
No screen/separation has been provided between delivery tables in labour room
Fumigation record and schedule not found. This may lead to sepsis to the patients undergoing delivery and post partum infection to mother and/or neo natal infections.
Adequate power backup was present.
Running water facility is available.
The essential Tray for the Labor room was present but not sufficient as per delivery load.
The Protocols of the Labor were not displayed.
New born corner not functioning in the delivery room
Biomedical waste Management and Infection Control:
Waste managment out soursed but due lake of supervition system not working properly.
Disposal system need be improve despite proper posters are displayed in the maximum places.
Color coded bins are being made available in all the departments.
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Immunization
The people bring their children to the immunization room along with immunization card. DPT, Polio, Measles, and BCG are the vaccines administered by the nurse.
All the new born are not administered BCG, OPV Zero dose and Hepatitis 0 dose.
Record of immunization incomplete in the assigned column of delivery register.
Laboratory Services
The District Hospital has a in-house lab with provides all major tests
Proper display of user charges and available tests separately is needed near the lab.
The equipments and instruments in the lab are properly arranged. The lab has clear demarcated areas of collecting testing and reporting.
Adequate storage facilities are available.
Infection control practices were found unsatisfactory
Regular AMC s of equipments is needed.
Integrated Counseling and Testing Centre (ICTC)
The hospital participates in the National AIDS Control Programme and has an ICTC center for the same. There are two counselors, a female at the ICTC centre/ room and a male counselor.
There are insufficient testing kits to test all ANC cases.
Lab technicians have shortage of hand globes, they are in risk.
Medical Records
New delivery register is not filled properly and completely.
Immunization, JSY , referral and departure time/date not entered.
There is no standared procedure to collect all data from different departments.
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Graphical Analysis
68.89 Infrastructure for ANC, Natal and PNC care 100.00
Knowledge & Skills Consumables and supplies 85.71 80.00 76.56
60.00
40.00 Maintenance of critical equipment and Reporting infrastructure 42.86 20.00 50.00
0.00
Record & Maintenance Anti natal care services 53.33
72.41
Bio-Medical Waste Management Delivery or Natal Care Records 83.33 19.84 Post natal care 68.57
Page | 71
1. ANC, Natal and PNC care-
Availability of infrastructure for ANC is adequet.
Duty roster of delivery ward’s staff nurse are changing very frequently.
Essential and specialty wise equipments and instruments were available in the examination rooms.
Proper privacy maintain during ANC checkup.
Running water and wash basin available.
Light on examination table is not sufficient.
Hygiene in delivery room and ward not proper.
SOPs not displayed in the labor room.
The essential Equipment Tray for the Labor room was not found as per delivery load.
2. Consumables and supplies -
Advanced plan to overcome the shortage of medicine in place.
Stock book not updated completely.
3. Maintenance of critical equipment and infrastructure
No proper CMC plane for most of the critical equipments.
Autoclave, baby wormer, Blood bank freez and some equipment in lab not functioning.
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4. Bio-Medical Waste Management
Hospial waste managmant has been out soursed, but due lack of supervision they are not performing well.
Improper segregation system in wards/OPDs.
Proper posters / IEC are not available in the many departments.
Colour coded bins are being made available in all the section
5. Record & Maintenance and Reporting-
New delivery register not filled completely. Immunization, JSY payment, referral and discharge time has not been entering by in-charge sister.
Partograph not maintained.
No standared procedure to collect data from different department, validation of HMIS report not in place.
Hospital Consultant is not aware about various data elements and their source.
6. Knowledge & Skills
Many staff nurse not traind in SBA, IMNCI and IUCD trained but not practice for partograph and complication management.
Other Key recommendations
1. The center should hold regular meeting of the Executive Committee of Jeevan Deep Samiti (which is not been held) and make plan for effective utilization of the fund.
2. Aluminium door partion should be made in the major OT through JDS.
3. Regular review of Mitanin Help Desk with reference to grievance and readressal
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SRM TEAM VISIT TO JASHPUR DISTRICT Monitoring and Supportive FROM 20/06/2013 TO Supervision of various District 24/06/2013 Health Facilities
Jashpur is one of the high focus districts of Chhattisgarh. The State Review Mission team visited the district to review the progress and identify the gaps of state run health service programs including NRHM/RCH including FP Programme, MCH wing, Referral Transport, Laboratory facilities available and Implementation of JSY, JSSK scheme etc. and to strengthen them through supportive supervision. SRM Team Members of the Visit:
Sl. no Name Designation 1 Dr. S. M. M. Murthy Deputy Director, DHS 2 Dr. Nirmal Verma Associate Professor, Dept. of PSM, Pt. JNM College, Raipur 3 Dr. Kamlesh Jain State Nodal Officer, DHS 4 Dr. Surendra Gupta District MNCH Consultant, Rajnandgaon, UNICEF 5 Dr. Anmol Minz PG Student, Dept. of PSM, Pt. JNM College, Raipur
List of Facilities Visited by the SRM team:
Date Type of Health Facility Name of the facility I/c 20/06/2013 1. PHC Sanna Dr. S. R. Xalxo 21/06/2013 2. PHC Bhelwa RMA Khuswant Yadav 21/06/2013 3. CHC Pharsabahar Dr. C. R. Bhagat 22/06/2013 4. District Hospital, Jashpur Dr. N. C. Nande 24/06/2013 5. CHC Pathalgaon Dr. James Minz Background of Jashpur district
Jashpur was a princely State before independence. In 1818, Jashpur State was brought under Surguja State for the purpose of efficient administration. However, till 1950, Jashpur was included as a princely State among Chhotanagpur States, administered by the Bengal Government. This arrangement continued till 1947-48. Jashpur remained a part of Chhotanagpur state from 1948 to October 10, 1956. On November 1, 1956 when Madhya Pradesh was organized as a new State under union of India, Jashpur became a part of it. Till May 25, 1998 this region remained a part of Raigarh District. On May 25, 1998 Mr. Ramanand Shukla took over the charge of collector of this newly constituted district. On organization of Chhattisgarh as a new State, Jashpur is a part of this province.
Situated in the north-east of Chhattisgarh, Jashpur is rich with dense forest and green flora. It is surrounded by Gumla district of Jharkhand in the east, Surguja in the west, some parts of Jharkhand and Surguja in the north and the districts of Raigarh and Sundargarh (Orissa) in the south. Geographically it is divided in two parts. The northern hilly belt, called Upper Ghat, running from Loroghat Kastura, Narayanpur, Bagicha up to the Surguja district covers Sanna, Bagicha and Narayanpur blocks. The remaining southern part is called nich Ghat or Lower Ghat.
Jashpur is primarily a tribal district dominated by Uraon caste and dependent on agriculture and forest produce. Following foreign missionaries its population started becoming literate through Primary, Middle and Higher secondary schools run by them. Other tribal castes residing in the district include Kanwar, Gond and Saonsar. Pahari Korwa, a primitive tribal group, is also seen settled in villages and adopting community life.
Some key demographic indicators of Jashpur District as per census 2011 Description 2011 2001 Actual Population 851,669 743,160 Male 424,747 371,697 Female 426,922 371,463 Population Growth 14.60% 13.23% Area Sq. Km 5,838 5,838 Density/km2 146 127 Proportion to Chhattisgarh Population 3.33% 3.57% Sex Ratio (Per 1000) 1005 999 Child Sex Ratio (0-6 Age) 980 975 Average Literacy 67.92 63.77 Male Literacy 77.32 75.16 Female Literacy 58.61 52.44 Total Child Population (0-6 Age) 122,266 122,934 Male Population (0-6 Age) 61,744 62,244 Female Population (0-6 Age) 60,522 60,690 Literates 495,415 395,548 Male Literates 280,656 232,587 Female Literates 214,759 162,961 Child Proportion (0-6 Age) 14.36% 16.54% Boys Proportion (0-6 Age) 14.54% 16.75% Girls Proportion (0-6 Age) 14.18% 16.34% Rural-Urban demographic Comparison of Jashpur District 2011 Description Rural Urban Population (%) 91.08 % 8.92 % Total Population 775,677 75,992 Male Population 386,307 38,440 Female Population 389,370 37,552 Sex Ratio 1008 977 Child Sex Ratio (0-6) 982 958 Child Population (0-6) 112,599 9,667 Male Child(0-6) 56,808 4,936 Female Child(0-6) 55,791 4,731 Child Percentage (0-6) 14.52 % 12.72 % Male Child Percentage 14.71 % 12.84 % Female Child Percentage 14.33 % 12.60 % Literates 439,818 55,597 Male Literates 250,617 30,039 Female Literates 189,201 25,558 Average Literacy 66.33 % 83.83 % Male Literacy 76.06 % 89.66 % Female Literacy 56.72 % 77.87 % General Information about Jashpur District Total No. 755 SC Female 18123 2.44% of Village ( CASTE(2001) Male 18277 2.46% Revenue) Total 36400 4.90% Forest 11 ST Female 236787 31.86% Village CASTE(2001) Male 233466 31.42% Total 469953 63.24% Revenue 10 Police Thana 11 Inspector Circle Municipal 1 SCHOOL Education ST Benefited Department Society Department Nagar 1 (A)Primary School 295 993 Panchayat Gram 417 (B)Middle School 88 216 Panchayat Janpad 8 (B)High School 2 22 Panchayat Legislative 4 (C)Higher Secondary 2 24 Assembly College 4 District Hospital 1 Private 2 Community Health 8 College Center Hand 8952 Primary Health Center 32 pump No. of Manora, Jashpur, Sub Health Center 259 Blocks: 8 Duldula, Kunkuri. Bagicha, Kansabel, Parsabahar, Pathalgaon Visit to District Hospital
The Jashpur district Hospital is located in the Jashpur block and have 100 beds with 10 additional beds for ophthalmic patients. It is strategically located near the main bus stand and market place accessible through all-weather road. The Civil Surgeon was not available during our visit.
The Hospital provides services in following facilities: General Medicine. Obstetrics and Gynecology Pediatrics Surgery ICU NRC Health care for elderly Ophthalmic surgeries Layout of the Hospital: 1. Out Patient Department: 1. RSBY/ MSBY counter 2. Patient registration Counter 3. Mitanin Help Desk 4. Drug Dispensing Counter 5. Doctors Consultation room 6. Pathology Lab 7. ANC clinic 2. In Patient Department 1. Operation Theatre 2. Labor Room 3. General Ward 4. Female Ward 5. Labor Ward 6. NRC 7. ICU 8. Health care for elderly etc.
Computerized OPD/ IPD Registration
The OPD/ IPD registration in the district hospital has been computerized. This system is located near the main entrance helps to keep proper data entry and record maintenance.
RSBY counter
There is separate counter for RSBY in the district hospital which offers RSBY/ MSBY services to the people.
Gap observed:
1. The hospital has a RSBY counter at location away from registration counter. 2. During the time of our visit 50 RSBY cards were found at the counter unauthorized i.e. in possession of the RSBY counter in absence of patients.
Mitanin Help Desk Two Mitanins were seen at the Mitanin Help Desk of the district hospital. They were from the nearby areas and informed that they attend the hospital in turn with other Mitanins of the nearby areas. They guide some of the new patients in availing various services and also counsel them on various health related subjects.
ANC Clinic
The ANC clinic is situated next to the ICTC clinic. Each medical officer maintains separate ANC register. There is adequate privacy for ANC examination. However, load of ANC case is relatively low.
Gap identified: For some patients routine lab investigations like Hb%, Urine sugar and albumin etc. are not performed. Proper record keeping is not maintained.
ICTC and STI clinic The hospital has one ICTC clinic with one counselor. However, no HIV+ case recorded in the last 2 months.
Labor Room
The labor room is well furnished offering complete privacy to the patient. There are curtains between the beds, door and windows. Most of the emergency medicines were found in the labor room. Partograph and AMTSL are being practiced by the labor room staff. However, only 3 Caesarian section deliveries were conducted in the last three months thought one gynecologist and one LSAS doctor is available in the facility. The referral register is not properly maintained and large numbers of complicated labor cases are being referred to a private facility located at Kunkuri. The labor room maintains the following tray Emergency medicine Tray with emergency Drug List. Medicine Tray Delivery Tray Baby Tray MVA Ambu bag kit pediatric and adult Gaps observed in the labor room 1. Kelley’s pad not found 2. Partograph not filled properly and active management of third stage of labor not performed 3. Regular BP, Hb tests etc. not carried 4. BMW management not followed as per protocol. Post Natal Ward The post natal ward was not separate. There was no display of JSY or JSSK benefits. IEC material regarding exclusive breast feeding up to six months, dangers signs in newborn or puerperal women were not displayed anywhere.
There is no separate post natal word Blood Storage Unit The hospital is having one blood storage unit but it is not functioning properly. The mother blood bank is located at Ambikapur from where inadequate amount of blood bags are infrequently received.
Gaps observed Blood for patients is collected outside the district hospital at unauthorized places instead of mother blood bank located at Ambikapur.
Operation Theatre
The operation theatre is well equipped and fumigation was carried out recently. ICU Health Care for Elderly
The 3 bedded ICU is located next to the OT. 1 Jashpur is one the district where National patient was seen admitted during the visit. Program for Health Care for Elderly has been launched in Chhattisgarh. A separate unit in the district hospital for the health care of elderly has been established.
Ophthalmic Operation Theatre The district hospital has 10 dedicated beds for ophthalmic services where routine eye operation is carried out.
NRC
A Nutritional Rehabilitation Centre has been established at the district hospital recently. It is well furnished with good patient load. There is one Feeding Demonstrator and one Cook. All required medicines for malnourished children were available. Patient party is being paid @ Rs. 100/ day on being discharged.
Gaps observed
1. 15% weight gain not seen 2. All the patients do not stay for 15 days 3. Reporting erroneous
AYUSH Wing 1. The AYUSH wing was found to be in good condition in terms of infrastructure as well as human resources. 2. There were adequate IEC materials in the wing.
Gaps identified and suggested measures:
1. There is not much visibility of AYUSH wing in the hospital and the wing is located on the first floor. It was suggested that adequate IEC activity be undertaken to have a better service delivery. There should be a display in the hospital enumerating the services available with the AYUSH wing. 2. Better coordination between the modern medicine and AYUSH wing is required in terms of referral and coordination.
X-ray Unit The hospital has one x-ray unit but there is no USG facility.
Store
The store was nicely arranged. The stock registers were up to date. The store keeper indeed had a good idea about the monthly requirement of various medicines and consumables. Most of the medicines did not stock out in the last three months.
Gaps identified
1. Adequate stocks for two months in advance not maintained. It should be maintained. 2. Large stock of dispersible zinc sulphate tablet found in the store which cannot be consumed in the short shelf life before expiry. Hence it has been suggested to distribute the medicine to all the blocks where it could be consumed before expiry. 3. There was inadequate stock of Anti-Snake Venom. A call was made to Jt. Director store and to provide 100 vials of ASV on a priority basis.
Bio Medical Waste Management
The hospital has initiated bio medical waste management across various departments of the hospital. The color coded bins have been provided and bio-medical waste management protocols have been displayed at several places.
Gaps identified 1. Proper waste segregation is not adopted properly by the staff. 2. In some places the bins remain unused.
Patient Waiting Area
There is adequate waiting area for the Patients and attendants. Special chairs have been installed for their use. A television set has been at the waiting area.
Gaps identified
1. Inadequate IEC material regarding various national health programs. 2. JSY, JSSK information not displayed here
Water Cooler for patient party A water cooler has been installed in the district hospital from the JDS fund.
Jeevan Deep Samiti JDS fund is being used for occasional repairing of electrical equipment and water supply. It is also being used for referral of patients using ambulance. An eclampsia bed has been purchased through this fund. Follow up Meeting with Hospital and CMHO office Staff
Following the visit to district hospital a meeting had been convened and attended by most of the staff of the district hospital and CMHO office. The main points discussed in the meeting are as following:
1. Emergency duty roster and Call roster needs to be developed and displayed at required places 2. The blood bank needs to be established on priority basis. 3. There should be an exclusive maternity ward for post natal cases as keeping general female patients and post natal cases may cause infection to highly susceptible post natal mothers and newborns. 4. The large stock of dispersible zinc sulphate tablets needs to be distributed to the blocks considering diarrheal cases tends to rise in monsoon across the district and the shelf life of the tablet stock is very short. 5. The store needs to develop and follow up a method to ensure that medicines and consumables are used before expiry 6. IEC activity needs to be improved. Various protocols related quality ANC services, delivery, exclusive breast feeding, and danger signs in post natal women and newborns need to be displaced at appropriate places. Similarly, IEC activity also needs to be undertaken for patient waiting area. JSY and JSSK entitlement needs to be displayed in the labor room and post natal ward. 7. Smart Card of RSBY should be always with the patients and should not be with RSBY counter. The documentation related to RSBY needs to be improved. There seems to be excess use of RSBY facilities even for admission of suspected cases of TB, a national program having enough provision for treatment and cure of all types of TB cases. 8. A periodical review on use of RSBY needs to be taken at both district and state level to ensure that RSBY is being used as per actual requirement and protocol. 9. There should be one separate register for referral of ANC, Delivery and PNC cases. Other registers needs to be updated. 10. Use of personal protective equipment like gown, cap, mask, goggles etc. should be adopted by staff working in the delivery room. 11. Partograph should be used for all delivery cases as well as AMTSL for each case should be undertaken. 12. Although there is one Gynecologist and a trained LSAS doctor yet only three LSCS were performed in the last three months. This needs to be improved considering this is a district hospital also considering that very few private hospitals capable of performing LSCS exist in the district. 13. All emergency medicines related to delivery should be always available in emergency drug tray. Also tab misoprostol should not be purchased from outside as there is adequate government supply. 14. Protocol for NBCC needs to be adhered to. 15. Proper sterilized delivery sets for each labor should be done using autoclave 16. Complete address of TB patients should be recorded in the IPD/ OPD registers to follow up cases as few drop out cases have been recorded. 17. Although it is one of the three districts where NCD programs have been launched yet even the MD physician working in the district hospital had no knowledge about it. There was glucometer but no gluco strips. Thus NCD lifestyle clinics have to be operationalized for diseases like diabetes and hypertension as soon as possible. 18. Bio medical waste segregation and disposal has to be followed as per the protocol 19. Needle cutter has to be used 20. Sodium hypochlorite solution is not available at any of the facility visited. It has to be supplied by the CMHO office for disinfection of needles and other bio medical waste. 21. The disposable mucus extractor for neonates should not be re-used 22. The DPM and BPMs as well as the Hospital consultant need to take periodical visits to various facilities in order to ensure functioning of facilities as per protocol on various aspects. 23. During the interaction of the SRM team at various sites, Sanna, Pharsabahar, district hospital etc., it has been learnt that Mitanins are yet unaware about the details of maternity and child health schemes like JSY and JSSK, some have not received their incentives while their school going children failed avail benefits of the scholarship scheme “Swabalamban”. The Mitanins are also facing some difficulty in receiving their incentives from the Panchayat department. The Nodal Officer for Mitanin needs to sort out this issue. Visit to CHC Bagicha
Although CHC Bagicha was not part of our scheduled visit yet at the suggestion of the CMHO, Jashpur our team leader Dr. SMM Murthy consented to visit the facility. It is a 30 bedded CHC with Dr. RN Dubey led the team to the Labor room, OPD, IPD, Laboratory etc. however, it was learnt that there is no Operation Theatre. There are inverter and solar system for power back up. He informed the team that there are 3 more Medical Officer and 1 RMA working in the facility. During the visit following points were observed.
1. Color coded bins were found to be used in the Labor room and Lab. 2. Autoclave is being used for sterilization. 3. Various Standard Operating Protocols regarding delivery were found to be followed. 4. Running water facility available. 5. IEC materials like display of danger signs of high risk pregnancy were displayed. 6. JSY register and IPD registers well maintained. 7. JSSK services are being offered 8. However, all the emergency medicines were not found in the emergency medicine tray. 9. Radiant warmer was found in an adjacent room and was not being used properly. 10. Bed sheets in the IPD room were not changed regularly. 11. No deep pits were found. 12. There is one lab for lab diagnosis of TB 13. The 7 bedded Nutritional Rehabilitation Centre was well functioning having most of the required medicines with one Feeding Demonstrator and a Cook. Total number of children admitted in June is 03. However proper admission criteria were not followed. Most of the patients did not stay the stipulated 15 days duration and neither gained the required 15% weight gain. Visit to CHC Pharsabahar
CHC Pharsabahar is a 12 bedded CHC with Dr. C. R. Bhagat as the BMO. The total population for the block is 112385 living in 97 villages. It is 80 km away from the district HQ. This health facility is easily accessible from nearest road and is functioning in government building. However, the building is not in good condition and a new building is under construction. It has habitable staff quarters for both MO and SN as well as for other staff. The daily OPD load is 40 – 50 patients.
There is 24 hour electric supply with solar power back and also has running water supply. There are separate toilets for male and female but they were found to be dirty. It has a functional newborn care corner. There is no blood storage unit or blood bank. There are only two specialist, one in surgery and other in medicine. In addition to that there are 4 MO, 4 SN, 1 ANM, 2 LT, 2 Pharmacists, 1 LHV, 1 Radiographer supported by other staff.
As it is supposed to be an FRU, hence it has 2 EmOC trained MO, 2 BEmOC trained staff.
1. Functional BP instrument with stethoscope, pediatric resuscitation kit, functional weight machines (adult and child), functional needle cutter, functional radiant warmer, functional suction apparatus, facility for oxygen administration, functional autoclave, ILR and DF available 2. The pathological lab conducts Hb%, Urine albumin and sugar, blood sugar, Malaria (PS and RDT), and TB tests. However, HIV testing is not available. 3. JSSK facility is offered to the patients. 4. OT is not operational 5. X-ray machine is not being used. 6. Sterilized delivery set not available. 7. Color coded bins were found to be used in the Labor room. 8. Autoclave is not used for sterilization. 9. Essential drug list is not displayed. 10. JSY register and IPD registers well maintained. 11. IPD diet is from outsourced party. 12. All the emergency medicines were not found in the emergency medicine tray. 13. Partograph not being used properly. 14. Common female ward where post natal cases are admitted. 15. Manual OPD register. 16. Each MO maintains a separate OPD register.
Following the survey of the facility a meeting was convened at the CHC campus where all the staff and medical officers assembled. The following points were discussed and agreed upon to improve:-
1. To ensure adequate availability of all generic medicines and equipment required for maternal and child health services. 2. Proper use of Partograph and AMTSL as well practice of essential newborn care for each newborn. 3. Maintaining of adequate stock of medicines and consumables for next two month and updated stock registers. 4. Proper utilization of various supply and consumables before expiry. In case of expired drugs and consumables proper guidelines shall be followed for their disposal to prevent environmental pollution. 5. During the JDS meeting reasons should be written against the sanctioned amount for expenditure. 6. Needle cutter will be used for destroying needles. 7. Hb% examination, Urine examination, BP and weight for each and every ANC and delivery case will be conducted. 8. The format for reporting of severe anemia will be made available from the CHC or CMHO store wherever available. 9. IEC activity regarding ANC, Delivery and PNC shall be displayed at appropriate places. 10. Proper counseling on exclusive breast feeding of babies up to six months, identification of dangers signs in newborn and mother. 11. A proper referral register will be maintained recording the main reasons for referral. 12. The MO and RMA must maintain the OPD register properly recording their provisional diagnosis for proper reporting.
Visit to CHC Pathalgaon CHC Pathalgaon is functioning from a newly constructed building of 100 bedded Civil Hospital. At present the CHC of 50 beds is functional. The facility is located on the main route of Ambikapur to Raigarh and located near the market place due to which the OPD and IPD load is very good. Dr. James Minz is the in-charge BMO of the facility.
OPD: Computerized OPD registration room with separate counters for OPD registration, delivery of reports of investigation and Medicine distribution. OPD registration fee is Rs. 5/- per head. Free for BPL, ANC, poor and RSBY patients. Sufficient space available for waiting room arrangement for patients at registration counter, but waiting room arrangement not made. BMO explained that as the entrance of hospital opens directly on to the main road, outsiders and anti-social elements create nuisance. Therefore waiting room arrangement is not made. Separate OPD examination rooms available for each doctor. Curtains not present at examination tables for privacy of patients. Footsteps present at some tables only. Hand washing facility for doctors is available but not comfortable.
Staff position:
A. Doctors:
1. Dr. Basant Kumar Singh, M.S. ENT;
2. Dr. P. Suthar, M. D. Medicine;
3. Dr. Smt. Anita Minz, M. S. Ophthalmology;
4. Dr. Shakuntala Nikunj, DLO; 5. Dr. J. Minz M. S. Surgery;
6. Dr. A. S. Thakur, M. B. B. S.
7. Dr. Surekha Bhagat, B. A. M. S. (AYUSH)
8. Swati Tripathi, R. M. A.
B. Staff Nurses – 13
C. Lab. Techs – 3
D. Pharmacists – 3
E. Ward Boys – regular – 3; attached – 8
E. N. T.: Cautery machine not available, Audiometry equipment required, 3 patients referred to ‘Bal Shravan Yojana.’
Eye: Separate Eye O. T. available, IOL surgeries are being done.
Patients’ waiting room: Well-equipped near OPD examination rooms.
Trauma Unit: Trauma Unit present with 2 beds.
RNTCP: Tuberculosis Unit present, staff new and untrained, MOTC is Dr. Minz from CHC Pharsabahar. Complete address is not being entered in the registers, transfer in and transfer out record not being maintained properly, Microscopic Centers are at Bagbah, Ludeg, Pharsabahar and Khurse.
X-Ray: 300 m. a. X-Ray machine present in working condition. Shri. Vijay Kumar Singh, Radiographer was interviewed. He said he has no problems. Sonography Machine is not available and is required.
ICTC Center: Present and functioning. Cross referrals between HIV/AIDS and RNTCP is not satisfactory.
Blood Storage Unit: Present and functioning. Consumption of blood is 8 to 10 units per month. Mother Blood Bank is at Ambikapur.
Pathology Lab: Well maintained. However, Lab techs are not using gloves and other PPE.
Injection Room: Well-maintained but staff is not well acquainted with the use of needle destroyer and Hub cutter.
Vaccine Store: Well-maintained with Solar Power back up. However, the vaccines were not stored as per the protocol displayed in the vaccine store. DPT and TT were stored in lower compartment and some of the vials were close to getting frozen. Regular monitoring of ILR and DF not undertaken, last time when the temperatures were monitored is 1st June as per the temperature monitoring chart. Labor Room: With 1 Labor table and 2 examination tables being used as labor tables. Curtains not present between tables, Baby Warmer, Ambu bag and emergency medicine tray available. Baby warmer is not working. Toilet not attached with LR. No running water facility. No delivery case sheet maintained. Labor room appears to be a make shift arrangement. For each labor case the hospital procures a delivery kit from a local chemists shop for which detailed break up is not available. The list of medicines also includes Methargin but Magnesium sulphate is not available. The Labor register is not updated. Sterilized delivery tray not used and autoclaving not done. Partograph is not used and AMTSL not practiced. It was learnt that every newborn is given oil bath and are not put on radiant warmer. Post natal counseling on breast feeding, dangers signs of mother newborn is not done. A good number of cases are referred to other facility but there is no referral register and the cause of referral is not recorded. There is no attached toilet and NBCC is in adjacent room and not in use.
Ante natal Ward: Combined with female general ward. Under JSSK, drop back services are not happening properly because patients do not stay for 48 hours after delivery. Indoor registers are being maintained. But Bed head tickets are not being maintained properly. It seems that none of the patients stay during night hours. Average No. of deliveries 3 per day and about 100 per month. JSY payments are being made. Wards are not having attached toilets.
Operation Theatre: With one O. T. table, Shadow less Lights, Boyle’s apparatus, LSAS trained Anesthetist available.
DATA Center: Well equipped with DEOs. PHC Computer Systems are also retained at CHC. Reason told by BMO is that there is no internet connectivity available at PHCs.
Bio-Medical Waste Disposal: Colored waste collection bins are available at all required places however they are not used as per protocol. Waste disposal is being done by deep burial method.
JDS: Records are being maintained. JDS Meetings are being conducted but no meeting in 2013 till date.
JSY: 7 cases were pending for payment as on 24.06.2013
Store: the store records are not updated. As medicines and consumables for each labor case is procured separately under JSSK hence the records in regular registers not updated.
Following the survey of the facility a meeting was convened at the CHC campus where all the staff and medical officers assembled. The following points were discussed and agreed upon to improve:-
1. To ensure adequate availability of all generic medicines and equipment required for maternal and child health services. 2. Immediate abandoning the use of inj. Methargin routinely. 3. Immediate repairing of electrical autoclave and its use. 4. Use of personal protective equipment like gown, cap, mask, goggles etc. should be adopted by staff working in the delivery room. 5. Proper use of Partograph and AMTSL as well practice of essential newborn care for each newborn. 6. Promotion of 48-hours stay to be encouraged. 7. Proper use of transport facility provided under JSSK for picking, referral and drop of patients. 8. Bedside tables with curtain for proper privacy of patients’ needs to be ensured. 9. Complete address of TB patients should be recorded in the IPD/ OPD registers to follow up cases as few drop out cases have been recorded. 10. All confirmed TB cases should be tested for HIV. 11. Use of Tab Nimesulide should be stopped immediately as it has been banned by the GOI. 12. Proper preparation and use of ORS solution explained to the nurses and other staff. 13. Maintaining of adequate stock of medicines and consumables for next two month and updated stock registers. 14. Proper utilization of various supply and consumables before expiry. In case of expired drugs and consumables proper guidelines shall be followed for their disposal to prevent environmental pollution. 15. Needle cutter will be used for destroying needles. 16. Hb% examination, Urine examination, BP and weight for each and every ANC and delivery case will be conducted. 17. The format for reporting of severe anemia will be made available from the CHC or CMHO store wherever available. 18. IEC activity regarding ANC, Delivery and PNC shall be displayed at appropriate places. 19. Proper counseling on exclusive breast feeding of babies up to six months, identification of dangers signs in newborn and mother. 20. A proper referral register will be maintained recording the main reasons for referral. 21. The MO and RMA must maintain the OPD register properly recording their provisional diagnosis for proper reporting. 22. In this CHC, an ENT specialist and a DLO both were found to be working. Appropriate measures at state level needs to be undertaken to ensure proper utilization of their expertize through relocation. Visit to PHC Sanna
The 24x7 PHC Sanna is strategically located PHC in a very hard to reach area of Bagicha block of Jashpur district catering to a population of 15893. It has 1 Medical Officer, 2RMA, 1LHV, 2 ANM, I Pharmacist, 1 Dresser, 1 Driver, 2 Peon and 1 Watchman. Dr. S. R. Xalxo is in charge of this institution. The normal OPD load is 15 -20 patients per day going up to 40 – 50 on market days. The IPD has 5 beds. There is no boundary wall or running water supply. IPD or labor room does not have attached toilets. There is no lab technician; an MPW carries out some lab investigations. Although it comes under CRMC, yet the LHV does not receive any CRMC allowance. There is no staff nurse although the delivery load is quite good.
Total numbers of delivery in last 3 months were 42 and total ANC cases seen in the facility was 98. During the last 3 months total 2 ANC cases, one of transverse lie and another of short heighted, early married primipara were referred. During the same period the facility has recorded cases of 3 still births and 2 neonatal deaths. Some other observations related to the facility are as following: -
1. Vaccine store was well maintained however vaccines were not arranged as per norms though a poster displaying proper storage of vaccine was available over the ILR. 2. 24 hours running water supply is not available. 3. There is no ANC room. Ante natal checkup is carried out in the OPD which lack privacy. Quality ANC checkup is inadequate. Records for Hb% examination, Urine examination, BP and weight for each ANC case were not found. 4. There are two ordinary beds in the labor room on which delivery is carried out. There is little space in the labor room to accommodate two beds without any partition or curtain between the two beds. The labor room lacks privacy. There is inadequate equipment to conduct normal delivery. There is no attached toilet. 5. The LHV and ANM who conduct the delivery have no knowledge about the use of radiant warmer or Ambu bag. They are also not practicing “Active Management of Third Stage of Labor” for all cases nor using Partograph for any delivery although they have received training on these subjects. Sterilization of ambu-bag was not done properly and the staffs were unaware of the harmful consequences of such malpractice. 6. The emergency drug tray did not contain all the emergency medicines, namely inj. Oxytocin, inj. Magnesium sulphate, inj. Gentamycin, Lignocaine, tab. Misoprostol, tab. Nifedepine, for normal delivery or to tackle any emergency that may arise. However, Methargin is being used in the facility for each delivery routinely after delivery. 7. Counseling on exclusive breast feeding, dangers signs in post-partum women or neonate is not done. 8. Autoclave is not available and the process of sterilization was found to be unsatisfactory. 9. The store keeper had not updated the stock register since 2010 for some medicines and consumables. 10. Although significant numbers of snake bite cases are reported in the area yet no anti-snake venom was found. 11. Although numbers of JDS meetings were more than 75% yet less than 25% of JDS fund has been spent so far. 12. Large numbers of gentian violet bottles were seen scattered at the backyard of the PHC. There were also large numbers of medicines, OCP and condoms improperly disposed.
At the end of the visit, our team leader along with other team members and staff of the PHC convened a meeting and discussed the findings of the SRM team. The MO of the PHC and BMO of Bagicha block agreed to ensure the following: -
1. Immediate abandoning the use of inj. Methargin routinely. 2. To ensure adequate availability of all generic medicines and equipment required for maternal and child health services. 3. Proper utilization of various supply and consumables before expiry. In case of expired drugs and consumables proper guidelines shall be followed for their disposal to prevent environmental pollution. 4. Construction of boundary wall shall be undertaken following a discussion during JDS meeting. 5. Construction of a proper labor room including toilet, with support of NRHM or RES as there is good number of deliveries, 10 – 20 per month. 6. The BMO has agreed to ensure 24 hour running water supply in coordination with PHE department by establishment of hand pump or bore well. 7. During the JDS meeting reasons should be written against the sanctioned amount for expenditure. 8. Oral Contraceptive pills, condom, gentian violets will be used wherever required. 9. Needle cutter will be used for destroying needles. 10. Hb% examination, Urine examination, BP and weight for each and every ANC and delivery case will be conducted. 11. The format for reporting of severe anemia will be made available from the CHC or CMHO store wherever available. 12. Labor tables will be installed in the labor room either from PHC Pandrapat, where it is lying idle or from block or district head quarter. 13. Radiant warmer will be properly used henceforth so that neonatal death can be reduced. 14. IEC activity regarding ANC, Delivery and PNC shall be displayed at appropriate places. 15. A proper referral register will be maintained recording the main reasons for referral. 16. The MO and RMA must maintain the OPD register properly recording their provisional diagnosis for proper reporting.
Visit to PHC Bhelwa
The 24x7 PHC Bhelwa is a strategically located PHC in a very remote area of Pharsabahar block of Jashpur district. It has 1 AYUSH Medical Officer, 1 RMA, 1 ANM, 1 Aya Bai, and 1 Male Supervisor. RMA Khuswant Yadav is in charge of this institution. The normal OPD load is 10 – 15 patients per day. The IPD has 4 beds. There is no boundary wall or running water supply. IPD or labor room does not have attached toilets. There is no staff nurse although the delivery load is quite good.
Total numbers of delivery in last 3 months were 33 and but no record for ANC cases found. Some other observations related to the facility are as following: -
1. The AYUSH system of medicine is very well functioning in the facility under Dr. M P Nayak. There is very good IEC activity and stock maintenance of AYUSH medicines. However, no synergy exists between him and the RMA. 2. Double fortified salt is being distributed to the beneficiaries from the facility. 3. The ILR and Deep Freezer though available at the facility is non-functional hence all the newborns are not immunized before discharge. 4. 24 hours running water supply is not available. 5. There is no ANC room. Ante natal checkup is carried out in the OPD which lack privacy. Quality ANC checkup is inadequate. Records for Hb% examination, Urine examination, BP and weight for each ANC case were not found. 6. There is one labor table in the labor room on which delivery is carried out, however it is damaged and needs to be replaced. The labor room provides adequate privacy. There is inadequate equipment to conduct normal delivery. There is no attached toilet. 7. The ANM who conduct the delivery have some knowledge about the use of radiant warmer or Ambu bag. However, she is not practicing “Active Management of Third Stage of Labor” for all cases nor using Partograph for each delivery although she has received training on these subjects. 8. The emergency drug tray did not contain all the emergency medicines, namely inj. Oxytocin, inj. Magnesium sulphate, inj. Gentamycin, Lignocaine, tab. Misoprostol, tab. Nifedepine, for normal delivery or to tackle any emergency that may arise. However, Methargin is being used in the facility for each delivery routinely after delivery. 9. Counseling on exclusive breast feeding, dangers signs in post-partum women or neonate is not done. 10. Autoclave is not available and the process of sterilization was found to be unsatisfactory. 11. The store is extremely poorly maintained. Large amount of expired bleaching powder stock was found in the PHC. Stock of medicines were scattered around the ground. 12. On further query and visit to the RMA quarter it was seen that two almirah and other government supplies were found in his quarter full of large amount of various drugs. 13. 7 vials of expired anti snake venoms, which have been thrown at the backyard of the PHC, were recovered at a time when the district is having acute shortage of it. 14. Almost 100% of JDS fund has been spent for which proper record is not available. 15. Gross misuse of RSBY scheme observed.
At the end of the visit, our team leader along with other team members and staff of the PHC convened a meeting and discussed the findings of the SRM team. The RMA of the PHC and BMO of Pharsabahar block agreed to ensure the following: -
1. Proper maintenance of OPD and IPD register with record of Rs. 5/- collected from each patient under JDS will be jointly maintained by the RMA and ANM. The BMO and BPM will monitor the registers periodically. 2. Proper utilization of various supply and consumables before expiry. In case of expired drugs and consumables proper guidelines shall be followed for their disposal to prevent environmental pollution. 3. The BMO has agreed to ensure 24 hour running water supply in coordination with PHE department by establishment of hand pump or bore well. 4. During the JDS meeting reasons should be written against the sanctioned amount for expenditure. 5. Oral Contraceptive pills, condom, gentian violets will be used wherever required. 6. Needle cutter will be used for destroying needles. 7. Hb% examination, Urine examination, BP and weight for each and every ANC and delivery case will be conducted. 8. The format for reporting of severe anemia will be made available from the CHC or CMHO store wherever available. 9. Proper use of Partograph and AMTSL as well practice of essential newborn care for each newborn. 10. Immediate abandoning the use of inj. Methargin routinely. 11. Proper counseling on exclusive breast feeding of babies up to six months, identification of dangers signs in newborn and mother. 12. Radiant warmer will be properly used henceforth so that neonatal death can be reduced. 13. IEC activity regarding ANC, Delivery and PNC shall be displayed at appropriate places. 14. Proper use of BMW management. 15. Proper use of RSBY scheme needs to be ensured and it will be monitored by the BMO and BPM. 16. The government supplies found at the quarter of the RMA needs to be returned to the facility so that proper store management is possible.
Visit to PHC Bhagora
Visit to SHC Bhagora Although PHC Bhagora was not part of scheduled visit but as it was en route Bhelwa so the team visited this facility as well. During the visit the ANM was not available at the facility. The facility was very badly managed. No delivery has been conducted for quite some time. Equipment were scattered around the room in haphazard manner. Some medicines and consumables were wasting in a corner of the room where other family members of the ANM were staying.
Thus it has been suggested that to prevent duplication and wastage of resources a SHC and a PHC should not be located juxtaposed to each other. The Bhagora SHC needs to be relocated at a distant place where its use could be optimized.
SSttaattee RReevviieeww MMiissssiioonn
(Supportive Super vision)
District - Surguja
Aim – The aims of supportive supervision are the collective efforts to find out the strength of health facility as well as the gaps and provide handholding support to the facility by team to operationalize with available resource.
Objective –
1. Constitution of joint team 2. Schedule field visit 3. Observation and recording the gaps 4. critical Analysis 5. supportive supervision 6. Documentation 7. Dissemination of findings and action taken 8. Follow-up and continuation of support
1. Team members :-
S.N. Name Designation Institute/Department /organization 1 Dr. khemraj Sonwani Deputy Director Dept.Health & FW
2 Mr. Anand Kumar Prog Manager M&E NRHM Sahu 3 Mr. Sanjay Sammadar Project Director HUP 4 Programme Mr. Mithun Dutta Cordinator(Quality DHS Assurance)
5 Dr. Ankur Sooden Consultant - UNICEF SSttaattee RReevviieeww MMiissssiioonn
(Supportive Super vision)
PRIMARY HEALTH CENTRE KAMLESHWARPUR District Sarguja
Detail observations and area of improvement
1. Approach and accessibility: i. The Primary Health Centre is situated on the top of the hill and well connected with road. ii. Prominent signages both near the road and on the building of the Primary Health Centre facilitate the easy location and identification of the Primary Health Centre from the main highway is not available.
2. Entrance: i. The entrances to the Primary Health Centre is not disable friendly ramp not available. ii. The entrances to the building have adequate space for simultaneous movement of more than one stretcher at a time and emergency equipments.
3. Waiting area: i. The Waiting area have not sufficient chairs for seating people, good quality steel chairs should be purchased from JDS.
4. Registration counter: i. Single manual registration Counter is Present. ii. On the registration counter prominent display of registration fee and timings and classification of different slips were Displayed
5. Consultation rooms: i. One Consultation room is available. ii. The room was prominent display name and qualification of doctor. iii. The consultation room has acute shortage of the space. iv. Examination tables steps are present but privacy has been not maintained fully. v. Hand washing facilities for the staff was not available.
6. Drug dispensing counter: i. The drug dispensing counter manned with a qualified pharmacist was present. ii. Timings for the opening and closing of dispensary are not displayed. iii. The Drug dispensing counter has a single window. iv. Near expiry drug list is not being maintained
7. In patient Wards: i. In the Primary Health Centre has 6 beds are functional. The Primary Health Centre consists of two general ward. One ward is extremely in unhygienic condition ii. The wards is near by with labor room. iii. The condition of beds was good. The beds were properly arranged. But next to each beds attendants stool, bed side lockers and IV stand were not present.
8. Labor room: i. New labour room is under construction , to speedup the construction agency DPM need to be follow . ii. The hygiene maintained in the labor. iii. Due to lake of space Position of labour table not conducive to easy working for nurses. iv. The labor room is full off other material also , that should be shifted to some were else. v. Adequate power backup was not present. vi. Wash basin and running water facility is not available. vii. The SBA protocols of the Labor were not displayed.
9. Biomedical waste Management and Infection Control: i. Proper posters are not available in the departments. ii. Colour coded bins are being made available in all the departments.
10. JDS meeting with all the staff by SRM team
Graphical Analysis
33.33
Infrastructure for ANC, Natal and PNC care 100.00 14.29 Knowledge & Skills Consumables and supplies 68.75 80.00
60.00
40.00 Maintenance of critical equipment and 14.29 Reporting infrastructure 20.00 8.33
0.00
Record & Maintenance Anti natal care services 53.33 5.17
Bio-Medical Waste Management Delivery or Natal Care Records 16.67 0.00 Post natal care
14.29 ANC, Natal and PNC care-
a. Availability of infrastructure for ANC, Natal and PNC are extremely less need to be improve. b. The SBA protocols of the Labor were not displayed. c. Kelly’s pad is not useable condition. d. Unnecessary material stored inside labour room . e. Dirty mucus suckers lying in labor room. f. Oxygen cylinder empty. g. Position of labour table not conducive to easy working for nurses. h. Toilet requiring urgent repair of roof, plaster falling off. i. Washbasins and running water not available in laborroom, ward, OPD and examination room.
2. Consumables and supplies - a. Stocks of medicine supplies are sufficient. b. Stock book not updated. c. No labels/labeled boxes for dispensing. d. Expired/soon to expire drugs and supplies stored injudiciously.
3. Maintenance of critical equipment and infrastructure a. New unused equipment lying for years and unusable, beyond repair and not required equipment stored in PHC leading to further constraint in available space. b. No plan for maintenance of non functioning equipments. c. 4. Bio-Medical Waste Management a. Improper disposal system . b. Proper posters are not available, colour coded bins are not available .
5. Record & Maintenance and Reporting- a. ANC and PNC record not maintain separately other than OPD or IPD. b. New delivery register not filled completely. Immunization, JSY payment, referral and discharge time has not been entering. c. Validation of HMIS and E-mahatary report not being done by any one. d. ANM register not verified by supervisor or sector doctor. 6. Knowledge & Skills a. Two newly recruited staff nurse posted in the PHC need to trained for IMCI, SBA, IUCD etc. 7. Other key Observations a. The center has very limited IEC material. b. Promotional advertisements by pharma companies pasted on walls. c. One RMA need to be posted. d. Roof requires repair, Space grossly inadequate. e. Room not available for Autopsies which are conducted in open ground and also equipment for autopsy not available.
Other Key recommendations
1. The center should start functioning more as 24x7 delivery center. 2. The center should hold regular meeting of the Executive Committee of Jeevan Deep Samiti (which is not been held) and make plan for effective utilization of the fund. Effective use of the fund available under Jeevan Deep Samiti after prioritizing the demands. Should avoid use of fund for which regular sources are available 3. To Bedside available lockers, IV statand, sterilization of goz bandaze . 4. I/V line maintained using 18G needle in pediatric case instead of using veinfon cannula or Butterfly set.
SSttaattee RReevviieeww MMiissssiioonn
(Supportive Super vision )
PRIMARY HEALTH CENTRE , BHAFAULI
District Sarguja
Aim – The aims of supportive supervision are the collective efforts to find out the strength of health facility as well as the gaps and provide handholding support to the facility by team to operationalize with available resource.
Objective –
9. Constitution of joint team 10. Schedule field visit 11. Observation and recording the gaps 12. critical Analysis 13. supportive supervision 14. Documentation 15. Dissemination of findings and action taken 16. Follow-up and continuation of support
2. Team members :-
S.N. Name Designation Institute/Department /organization 1 Dr. khemraj Sonwani Deputy Director Dept.Health & FW
2 Mr. Anand Kumar Prog Manager M&E NRHM Sahu 3 Mr. Sanjay Sammadar Project Director HUP 4 Programme Mr. Mithun Dutta Cordinator(Quality DHS Assurance)
5 Dr. Ankur Sooden Consultant - UNICEF Detail observations and area of improvement
11. Approach and accessibility: iii. The Community Health Centre is well connected with all weather road and is situated 10K.M. away from Ambikapur. iv. Prominent signages both near the road and on the building of the Primary Health Centre facilitate the easy location and identification of the Primary Health Centre from the main highway is not available. v. The Primary Health Centre is surrounded by a muddy road and Iron Gate .
12. Entrance: iii. The entrances to the Primary Health Centre is not disable friendly ramp not available. iv. The entrances to the building have adequate space for simultaneous movement of more than one stretcher at a time and emergency equipments.
13. Waiting area: ii. The Waiting area have sufficient chairs for seating people, good quality steel chairs have been purchased from JDS.
14. Registration counter: iii. Single manual registration Counter is Present. iv. On the registration counter prominent display of registration fee and timings and classification of different slips were Displayed
15. Consultation rooms: vi. Two Consultation room are available. vii. The rooms were prominent display name and qualification of doctor. viii. The consultation rooms are well ventilated, clean and hygienic. ix. Examination tables with screen and steps are present. x. Hand washing facilities for the staff was not available.
16. Drug dispensing counter: v. The drug dispensing counter manned with a qualified pharmacist was present. vi. Timings for the opening and closing of dispensary are not displayed. vii. The Drug dispensing counter has a single window. viii. Near expiry drug list is not being maintained
17. In patient Wards: iv. In the Primary Health Centre has 6 beds are functional. The Primary Health Centre consists of two general ward. v. The wards is attached with a labor room. vi. The condition of beds was good. The beds were properly arranged. Next to each beds attendants stool, bed side lockers were not present.
18. Labor room: viii. The hygiene maintained in the labor room was not satisfactory. ix. Labor tables were properly arranged with movable screen in between, . x. The labor room is marbled on floors and up to 7 ft in the wall. xi. Adequate power backup was present. xii. Running water facility is not available. xiii. The essential Tray for the Labor room was not present. xiv. The Protocols of the Labor were not displayed.
19. Biomedical waste Management and Infection Control: iii. Proper posters are not available in the departments. iv. Colour coded bins are being made available in all the departments v. Disinfection through 1 % sodium chloride is not being practiced.
Graphical Analysis
44.44 Infrastructure for ANC, Natal and PNC care 100.00
Knowledge & Skills Consumables and supplies 21.43 80.00 81.25
60.00
40.00 Maintenance of critical equipment and Reporting infrastructure 20.00 42.86 25.00 0.00
Record & Maintenance Anti natal care services 10.34 33.33
Bio-Medical Waste Management Delivery or Natal Care Records 34.92
66.67 Post natal care
37.14 8. ANC, Natal and PNC care- a. Availability of infrastructure for ANC, Natal and PNC is good but utilization need to be improve. b. The Protocols of the Labor were not displayed. c. Kelly’s pad not available. d. Disposable mucus suckers/ suction tube/ Infant feeding tube being reused. e. 9. Consumables and supplies - a. Stocks of medicine supplies are sufficient. b. Stock book not updated completely. c. No labels/labeled boxes for dispensing.
10. Maintenance of critical equipment and infrastructure a. Baby wormer not in functioning condition. b. 11. Bio-Medical Waste Management a. Improper disposal system . b. Proper posters are not available, colour coded bins are not available . c. Disinfection through 1 % sodium chloride is not being practiced.
12. Record & Maintenance and Reporting- a. New delivery register not filled completely. Immunization, JSY payment, referral and discharge time has not been entering. b. Validation of HMIS and E-mahatary report not being done by any one. c. ANM register not verified by supervisor or sector doctor. 13. Knowledge & Skills a. RMA practice as use of partograph and complication management. 14. Other key Observations a. The center is not functioning as 24x7 PHC . b. The center has very limited IEC material. c. Promotional advertisements by pharma companies pasted on walls. d. The PHC is under staffed and less utilized and staffs are under trained. e. It seems that the Nurse and RMA are handling most of the deliveries in the institute. It was found that the referral out of deliveries form this center to higher institute was not mentioned in the record. (which is little strange of any facility which is conducting more than 10 deliveries in a month ) f. The records of the patient were not kept properly. Even in still birth Hepatitis B immunization was given shown as per the record g. Though the center is 24X7 but none of the staff (doctor /RMA/ Paramedical) are staying after 6 pm
Other Key recommendations
5. The center should start functioning more as 24x7 delivery center. 6. The center should hold regular meeting of the Executive Committee of Jeevan Deep Samiti (which is not been held) and make plan for effective utilization of the fund. Effective use of the fund available under Jeevan Deep Samiti after prioritizing the demands. Should avoid use of fund for which regular sources are available
SSttaattee RReevviieeww MMiissssiioonn
(Supportive Super vision)
COMMUNITY HEALTH CENTRE, UDAIPUR District Sarguja
Detail observations and area of improvement
20. Approach and accessibility: vi. The Community Health Centre is well connected with all weather road and is situated on the National Highway Connecting Raipur to Ambikapur. vii. Prominent signages both near the road and on the building of the Community Health Centre facilitate the easy location and identification of the Community Health Centre from the main highway is not available. viii. The Community Health Centre is surrounded by a muddy road and Iron Gate leading to the main Community Health Centre building. The campus also includes the staff quarters. ix. The Community Health Centre Does not have any designated area for parking of vehicles.
21. Entrance: v. The entrances to the Community Health Centre is disable friendly with provision of ramp but handrail is not present with the ramp. vi. The entrances to the building have adequate space for simultaneous movement of more than one stretcher at a time and emergency equipments. .
22. Waiting area: iii. The corridor leads into a huge waiting space built of marble for easy cleaning with prominently displayed registration counter at the front. iv. Signages regarding regarding the national Programmes and other necessary information are well displayed. v. The Waiting area does not have sufficient chairs for seating people.
23. Registration counter: v. Single manual registration Counter is Present. vi. On the registration counter prominent display of registration fee and timings and classification of different slips were Displayed vii. Pre printed formats for OPD slip was used viii. The registers were complete and up to date with daily totals done at the end of the column.
24. Mitanin Help Desk: i. Mitanin Help Desk is present at the Community Health Centre Enterance. ii. The register of the Mitanin was foun up to date Complete.
25. Consultation rooms: xi. Thre Consultation room are available. xii. The rooms were serially numbered with prominent display of number, name, qualification of doctor. xiii. The consultation rooms are well ventilated, clean and hygienic. xiv. Examination tables with screen and steps are present. xv. Hand washing facilities for the staff was satisfactory. Essential and specialty wise equipments and instruments were available in the rooms.
26. Injection room and dressing room : i. Injection room is located adjacent to the Pharmacy. ii. The Emergency medicine tray is not being maintained in the injection room. iii. The neddle cutter was not available in the injection room.
iv. Infection control practices were found unsatisfactory with unavailability of proper IEC and improper use of PPEs. v. Daily injection record and stock registers were well maintained and were up to date.
27. Drug dispensing counter: ix. The drug dispensing counter manned with a qualified pharmacist was present. x. Timings for the opening and closing of dispensary are not displayed. xi. The Drug dispensing counter has a single window. xii. Near expiry drug list is not being maintained
28. Pathology Lab : i. The Community Health Centre has a in-house lab with provides basic routine tests ii. The services are offered during OPD hours. iii. Proper display of user charges and available tests separately is needed near the lab. iv. The equipments and instruments in the lab are properly arranged. The lab has clear demarcated areas of collecting testing and reporting.
v. Adequate storage facilities are available. vi. Refrigerator is not available.. vii. Infection control practices were found viii. Uunsatisafacory ix. Regular AMC s of equipments is needed.
29. In patient Wards: vii. In the Community Health Centre all the 30 beds are functional. The Community Health Centre consists of two general ward one each for male and female. viii. The wards is attached with a nursing station ix. The condition of beds was average. The beds were properly arranged. Next to each beds attendants stool, IV stand and bed side lockers were present. x. Diet was provided to the patients by outsourcing the food services. Quality of food was found satisfactory.
xi. Waste management and infection control practices were found unsatisfactory. It was suggested to keep general waste bins below the patient beds for easy segregation at source and non mixing of general waste with the infectious waste. xii. Records with up to date entries of discharge and LAMA were maintained. 30. Operation Theater: i. Operation Theatre is functional for LTT,CTT and NSV Surgeries. ii. Major Surgeries are not being conducted.. iii. Running water facility is not available in the operation Theatre iv. The necessary Equipment are available in the Operation Theatre. v. Autoclave is available. vi. Zoning of the Operation Theatre is not present. vii. Emergency Drug Tray is not present. viii. On the Drum that are Sterlized,the Date of sterilization is not present.
31. Labor room: xv. The hygiene maintained in the labor room was satisfactory. xvi. Labor tables were properly arranged with movable screen in between, the labor tables were covered with Macintosh and Kellies pad at the end leading to yellow buckets below the table. xvii. All trays and instruments required were well maintained under the charge of an SBA trained staff nurse. xviii. The labor room is marbled on floors and up to 7 ft in the wall. xix. Adequate power backup was present. xx. Running water facility is available. xxi. The essential Tray for the Labor room was present. xxii. The Protocols of the Labor were not displayed.
NBCC i. NBCC is available inside the labor room with proper provisions of incubator and emergency resuscitation kit consisting of Ambu bag, weighing machine, clips forceps towels, slide claps, feotoscpe and mucus extractor. ii. Services of pediatrician are not available.
32. Biomedical waste Management and Infection Control: vi. Improper disposal system vii. Deep pits and sharp pits are not constructed, viii. Proper posters are not available in the departments. ix. Colour coded bins are being made available in all the departments x. Disinfection through 1 % sodium chloride is not being practiced. xi. PPEs used by the staff is not satisfactory.
Graphical Analysis
55.56 Infrastructure for ANC, Natal and PNC care 100.00
Knowledge & Skills Consumables and supplies 7.14 80.00 71.88
60.00
40.00 Maintenance of critical equipment and 28.57 Reporting infrastructure 20.00 50.00
0.00
33.33 Record & Maintenance Anti natal care services 25.86
Bio-Medical Waste Management Delivery or Natal Care Records 20.63 16.67
Post natal care 20.00 15. ANC, Natal and PNC care- a. Availability of infrastructure for ANC, Natal and PNC is good but quality and utilization need to be improve. b. Light on examination table is not sufficient. c. The Protocols of the Labor were not displayed. d. Labor room approach from OPD/IPD uncovered(Open to sky), making it difficult for clients to be shifted during rain, storm etc. e. New born care corner not maintained properly, dust settled on top of radiant warmer . f. Kelly’s pad not available. g. Disposable mucus suckers/ suction tube/ Infant feeding tube being reused. h. Open drain inside hand washing area separating two labor rooms PNC ward next to labor room not maintained, fan/cooler not working i. No proper approach for wheeled stretcher. j. Workers not aware of using correct low pressure suction for resuscitation of newborns despite having a variable pressure suction machine. Foot operated suction machine out of order. k. Medicine trays in labor room not maintained properly Staff posted in labor room either not trained in SBA or quality of training is poor. (number of deliveries handled during training is only 2-3 for those trained). SBA protocol posters not displayed
16. Consumables and supplies - a. Stocks of medicine supplies are sufficient. b. Stock book not updated completely. c. Equipment not required stored in dispensing room e.g. Guedel airway, Endotracheal tube etc. d. Tablet/Capsule strips being cut without any regard to expiry date portion being retained. e. Recording method for dispensed drugs not correct . f. No labels/labeled boxes for dispensing and no record being maintained for injections given/stocked. g. Filled syringes lying recapped . h. Tetanus toxoid injection stored in room temperature
17. Maintenance of critical equipment and infrastructure a. Baby wormer not in functioning condition. b. 18. Bio-Medical Waste Management a. Improper disposal system . b. Proper posters are not available in the departments. c. Colour coded bins are not available in all the departments d. Disinfection through 1 % sodium chloride is not being practiced.
19. Record & Maintenance and Reporting- a. New delivery not filled completely. Immunization, JSY payment, referral and discharge time has not been entering by in charge sister. b. The record keeping at each point of patient contact is not as desired. The OPD register is not filled (it is very difficult to decipher valuable information for planning and monitoring). The drug dispensing unit is not keeping proper list of medicine distributed on daily basis. The information of the inpatients was not available during the visit. c. Partograph not maintain . d. Validation of HMIS and E-mahatary report not being done by any one. e. ANM register not verified by supervisor or sector doctor. 20. Knowledge & Skills a. SBA trained staff nurse not using the protocol of delivery room. b. Trained staff not practice as use of partograph and complication management. c. It was found that the HR are not trained on quality issue as the paramedical staff (Nurse, ANM, RMA) are not following basic injection safety measures, waste management protocol, patient privacy. Not adhering to injection safety protocol could lead to hazardous consequences both for the service provider and the patients d. 21. Other key Observations a. This center is grossly underutilized. b. The center is not functioning as FRU CHC rather as a stand-alone CHC with minimum linkages with the associated PHCs and Sub Health center. When asked the BMO or the BPM could not elaborate on the linkage plan c. The center is not adequately equip to handle cases related to trauma (especially accident cases ) as the center is bound to get such cases due to its location. d. The center has added advantage of getting technical and financial input from CSR activity of Adani Power but due to lack of coordination and understanding the benefit can of this association has not fully materialized e. The inpatient facilities are not as per the standard expected from FRU CHC. All that is required to improve the services is to be sensitive to the hardship experienced by the mothers and their relatives during the stay in the hospital. f. The community engagement process is also lacking like the Mitanin posted in Mitanin Help Desk is not receiving her remuneration regularly (three month gap). g. The center has very limited IEC material, and information notice board displayed which culminate into loss of huge opportunity to see of these IEC materials h. Notices pasted on registration window, no notice board. i. Promotional advertisements by pharma companies pasted on walls.
Other Key recommendations
7. The HR need training and the District Training Consultant should take stock of current capacity and develop a training calendar. After the training the staff should be allocated responsibility in writing with clear role clarity 8. The BPM and the staff needed hand holding support for DPM at the initial period. The BPM should prepare a flow chart of the center and identify patient contact point and strengthen each point, data recording, patient handling, display of relevant IEC materials, inventory management and recording, patient over all experience. The BPM should conduct exist interview of few patients on regular basis and find out the gaps in quality of services as per their perspective. And with BMO should find out resource to plug in those gaps. 9. Effective use of the fund available under Jeevan Deep Samiti after prioritizing the demands. Should avoid use of fund for which regular sources are available 10. The center should start functioning more as Comprehensive Health Care Services than a level 2 RCH center. 11. To achieve the efficiency of the structure outside interventions are least required, the staffs of the hospital especially the BMO and BPM is capable to do so, only thing is require is the desire to do it. Intervention like record keeping in proper formats, inventory management, filling up the partogram, display of IEC materials, follow infection control protocol, waste management require intervention at the central level. 12. The DPM should give visit to such centers and spend time with the BPM , BMO and chalk out plan to strengthen the hospitals. He /She should not wait for the letters/ guideline from state authority. The CMHO should give a timeframe within which the DPM should be able the rectify the mistakes and fill the gaps identified 13. The center should hold regular meeting of the Executive Committee of Jeevan Deep Samiti (which is not been held) and make plan for effective utilization of the fund. And avoid wasting the fund in purchasing items of personal comfort, HR etc.
SSttaattee RReevviieeww MMiissssiioonn
(Supportive Super vision)
COMMUNITY HEALTH CENTRE, SITAPUR District Sarguja
Detail observations and area of improvement
33. Approach and accessibility: x. The Community Health Centre is well connected with all weather road and is situated on the Highway Connecting Mainpat to Ambikapur. xi. Prominent signages both near the road and on the building of the Community Health Centre facilitate the easy location and identification of the Community Health Centre from the main highway is available. xii. The Community Health Centre is surrounded by an all weather road and Iron Gate leading to the main Community Health Centre building. The campus also includes the staff quarters. xiii. The Community Health Centre does not have any designated area for parking of vehicles.
34. Entrance: vii. The entrances to the Community Health Centre are disable friendly with provision of ramp but handrail is not present with the ramp. viii. The entrances to the building have adequate space for simultaneous movement of more than one stretcher at a time and emergency equipments.
.
35. Waiting area: vi. The corridor leads into a huge waiting space built of marble for easy cleaning with prominently displayed registration counter at the front. vii. Signage regarding the national Programme and other necessary information are well displayed. viii. The Waiting area has fixed chairs / Platform for seating people.
36. Registration counter: ix. Single manual registration Counter is Present. x. On the registration counter prominent display of registration fee and timings and classification of different slips were Displayed xi. Pre printed formats for OPD slip was used xii. The registers were complete and up to date with daily totals done at the end of the column.
37. Mitanin Help Desk: iii. Mitanin Help Desk is present at the Community Health Centre Entrance. iv. The register of the Mitanin was found up to date . v. The sitting facility not proper 38. Consultation rooms: xvi. Two Consultation room are available. xvii. The rooms were serially numbered with prominent display of number, name, and qualification of doctor. xviii. The consultation rooms are well ventilated, clean and hygienic. xix. Examination tables with screen and steps are present. xx. Running water/ Hand washing facilities for the staff was not satisfactory. specially in ANC room.
39. Injection room and dressing room : vi. Injection room is located adjacent to the Pharmacy. vii. The Emergency medicine tray is not being maintained in the injection room. viii. The needle cutter was not available in the injection room ix. Infection control practices were found unsatisfactory with unavailability of proper IEC and improper use of PPEs. x. Daily injection record and stock registers were well maintained and were up to date.
40. Drug dispensing counter: xiii. The drug dispensing counter manned with a qualified pharmacist was present. xiv. Timings for the opening and closing of dispensary are not displayed. xv. The Drug dispensing counter has a single window. xvi. Near expiry drug list is not being maintained
41. Pathology Lab : x. The Community Health Centre has a in-house lab with provides basic routine tests xi. The services are offered during OPD hours. xii. Proper display of user charges and available tests separately is needed near the lab. xiii. The equipments and instruments in the lab are properly arranged. xiv. The lab has clear demarcated areas of collecting testing and reporting. But not ergo logically to Lab technician xv. Adequate storage facilities are available. xvi. Refrigerator is not available.. xvii. Infection control practices were found unsatisfactory xviii. Regular AMC s of equipments is needed.
42. In patient Wards: xiii. In the Community Health Centre all the 30 beds are functional. The Community Health Centre consists of three general ward one each for male and female and children. xiv. The wards is attached with a nursing station xv. The condition of beds was average. The beds were properly arranged. Next to each beds attendants stool, IV stand and bed side lockers were present. xvi. Diet was provided to the patients by outsourcing the food services. Quality of food was found satisfactory.
xvii. Waste management and infection control practices were found unsatisfactory. It was suggested to keep general waste bins below the patient beds for easy segregation at source and non- mixing of general waste with the infectious waste. xviii. Records with up to date entries of discharge and LAMA were maintained. 43. Operation Theater: ix. Operation Theatre is functional for LTT,CTT and NSV Surgeries. x. Major Surgeries are not being conducted.. xi. Running water facility is available in the operation Theatre xii. The necessary Equipment is available in the Operation Theatre. xiii. Autoclave is available. xiv. Zoning of the Operation Theatre is present. xv. Emergency Drug Tray is present. xvi. On the Drum that are Sterilized, the Date of sterilization is not present.
44. Labor room: xxiii. The hygiene maintained in the labor room was unsatisfactory. xxiv. Labor tables were in very bad condition. xxv. Labor room has two tables of which both were found to be broken. xxvi. All trays and instruments required are not properly maintained under the charge of an SBA trained staff nurse. xxvii. The labor room is marbled on floors and up to 7 ft in the wall. xxviii. Adequate power backup was present. xxix. Running water facility is available. xxx. The essential Tray for the Labor room was not present. xxxi. The Protocols of the Labor were not displayed.
NBCC iii. NBCC is available inside the labor room with proper provisions of incubator and emergency resuscitation kit consisting of Ambu bag, weighing machine, clips forceps towels, slide claps, fetal scope and mucus extractor. iv. Services of pediatrician are available.
45. Biomedical waste Management and Infection Control: xii. Improper disposal system xiii. Deep pits and sharp pits are not constructed, xiv. Proper posters are not available in the departments. xv. Colour coded bins are being made available in all the departments xvi. Disinfection through 1 % sodium chloride is not being practiced. xvii. PPEs used by the staff is not satisfactory.
3. Graphical Analysis
48.89 Infrastructure for ANC, Natal and PNC care 100.00 Knowledge & Skills Consumables and supplies 80.00 81.25 7.14 60.00
40.00 Maintenance of critical equipment and Reporting infrastructure 20.00 14.29 41.67 0.00
Record & Maintenance Anti natal care services
33.33 37.93
Bio-Medical Waste Management Delivery or Natal Care Records
33.33 24.60 Post natal care 48.57
22. ANC, Natal and PNC care- a. As shown in the radar graph average facility available for ANC, Natal and PNC. b. Essential and specialty wise equipments and instruments were not available in the examination rooms. c. Proper privacy not maintain during ANC checkup. d. Running water and wash basin not available. e. Light on examination table is not sufficient. f. Hygiene in delivery room and ward not maintain. g. SOPs not displayed in the labor room. h. The essential Tray for the Labor room was not found.
23. Consumables and supplies - a. Stocks of medicine supplies are sufficient. b. Stock book not updated completely. c. Issue system need to be update as instruction given by SRM team.
24. Maintenance of critical equipment and infrastructure a. Baby wormer not in functioning condition. b. Some equipment in the laboratory is not maintained.
25. Bio-Medical Waste Management a. Improper disposal system b. Deep pit was not constructed, c. Proper posters / IEC are not available. d. Colour coded bins are being made available in all the section e. Disinfection through 1 % sodium chloride is not being practiced. f. PPEs used by the staff are not satisfactory.
26. Record & Maintenance and Reporting- a. New delivery not filled completely. Immunization, JSY payment, referral and discharge time has not been entering by in charge sister. b. Follow-up register of TB unit’s record not matched with the lab record. c. OPD register has not proper information. d. Partograph not maintain. e. Validation of HMIS and E-mahtary report not being done by any one. f. ANM register not verified by supervisor or sector doctor. 27. Knowledge & Skills a. SBA trained staff nurse not using the protocol of delivery room. b. Trained staff not practices as use of partograph and complication management. 28. Other key Observations a. This center is grossly underutilized and display a barren look in most of the aspect and new construction are going on for expansion b. The Glass Syringes which has been discontinued is still used in this center which shows complete ignorance of the staff and doctors c. The Pathology lab is well equipped and also lot of consumables and reagent are lying attended, some not even opened to check for the content. The Pathologist and his team are not utilizing the setup and the equipment to the fullest. d. Standard Treatment Protocol are not followed (RNTCP, and Doctors prescribing ORS packet to patient of Blood Pleasure)
Other Key recommendations
1. The BPM and the staff needed hand holding support for DPM at the initial period. The BPM should prepare a flow chart of the center and identify patient contact point and strengthen each point, data recording, patient handling, display of relevant IEC materials, inventory management and recording, patient over all experience. The BPM should conduct exist interview of few patients on regular basis and find out the gaps in quality of services as per their perspective. And with BMO should find out resource to plug in those gaps. 2. Effective use of the fund available under Jeevan Deep Samiti after prioritizing the demands. Should avoid use of fund for which regular sources are available. 3. The center should start functioning more as Comprehensive Health Care Services than a level 2 RCH center. 4. To achieve the efficiency of the structure outside interventions are least required, the staffs of the hospital especially the BMO and BPM is capable to do so, and only thing is require is the desire to do it. Intervention like record keeping in proper formats, inventory management, follow infection control protocol, waste management require intervention 5. The DPM should give visit to such centers and spend time with the BPM , BMO and chalk out plan to strengthen the hospitals. He /She should not wait for the letters/ guideline from state authority. The CMHO should give a timeframe within which the DPM should be able the rectify the mistakes and fill the gaps identified 6. The center should hold regular meeting of the Executive Committee of Jeevan Deep Samiti (which is not been held) and make plan for effective utilization of the fund. And avoid wasting the fund in purchasing items of personal comfort, HR etc.
SSttaattee RReevviieeww MMiissssiioonn
(Supportive Super vision)
Raghunath
District Hospital, Ambikapur
DISTRICT HOSPITAL AMBIKAPUR– AN INTRODUCTION
The Raghunath District Hospital, Ambikapur was started in year 1933-34. On 12 June 2004, Dr. Raman Singh, the chief minister has declared it a 300 beded hospital The hospital caters to a population of about 25 Lakhs locally from the surguja district and also referrals from various Community Health Centers (CHC), Primary Health Centers (PHC). The total built up area of the Hospital is 32, 605 sqm. and the whole premises covers an area of 8.20 acres. Its distance from the bus station and railway station is about 1 km. & 8 km. respectively.
The Hospital building has a well defined boundary wall. The wall inside the hospital is well plastered. Essential services including Out Patient Department (OPD), Indoor Patient Services (IPD) and Emergency Services are available in the hospital.
Apart from this, there are special services like:
1) General Medicine, 2) General Surgery, 3) Obstetrics and Gynaecology, 4) Ophthalmology 5) Orthopedics 6) Pediatrics 7) Dental Surgery 8) ENT
The inpatient department has a total of 340 beds laid out as against sanctioned bed strength of 300. Operation theatre is located in the ground floor and is well connected with the wards, blood bank, and diagnostic services. Hospital has a pharmacy counter for dispensing drugs to OPD Patient. Blood bank is available in hospital. The Hospital has also started working on infection control programme and has an Infection Control Committee (ICC).
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Detail observations and area of improvement
SERVICES AT THE DISTRICT HOSPITAL
District Hospital, Ambikapur is a combined hospital offering preventive and curative services to the community. The hospital is a general hospital and currently provides OPD services in following specialties. General Medicine General Surgery Obstetrics and Gynecology Orthopedics Pediatrics E.N.T Ophthalmology Dental surgery.
46. Approach and accessibility: xiv. The District Hospital is well connected with all weather road and is situated on the main road of Ambikapur. xv. Prominent signages both near the road and on the building of District Hospital facilitate the easy location and identification of the District Hospital from the main road.
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47. Entrance: ix. The entrances to the District Hospital are disable friendly with provision of ramp. x. The entrances to the building have adequate space for simultaneous movement of more than one stretcher at a time and emergency equipments.
.
48. Waiting area: ix. The corridor leads into a huge waiting space with prominently displayed registration counter at the front. x. Signages regarding regarding the national Programmes and other necessary information are well displayed. xi. The Waiting area has fixed chairs for seating people.
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49. Registration counter: xiii. Computerized registration Counter for male and female is Present. xiv. On the registration counter prominent display of registration fee and timings and classification of different slips were Displayed xv. Computerized formats for OPD slip was used xvi. There is lacking of Que management
50. Mitanin Help Desk: vi. Mitanin Help Desk is present at the District Hospital Entrance, but not prominent display of Mitanin sitting place. The register of the Mitanin was found up to date Complete. 51. Consultation rooms: xxi. The rooms were prominent display of name, qualification of doctor. xxii. The consultation rooms are well ventilated, clean and hygienic. xxiii. Examination tables with screen and steps are present. xxiv. Hand washing facilities for the staff was not satisfactory.
52. Injection room and dressing room : xi. Injection room is located adjacent to the Pharmacy. xii. The Emergency medicine tray is not being maintained at the injection corner. xiii. The needle cutter was not available at the injection corner xiv. Infection control practices were found unsatisfactory with unavailability of proper IEC and improper use of PPEs. xv. Daily injection record and stock registers were not maintained. xvi. Staff carries filled injection from pharmacy to corner and disposed back. xvii. The staff submits that they gets needle injury
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53. Trauma ward: There is provision of separate ward for trauma cases but Emergency drugs, Live saving equipment like Suction machine, defebrilator are out of order. The electric socket was damaged. 54. Drug dispensing counter:
xvii. The drug dispensing counter manned with a qualified pharmacist was present. xviii. Timings for the opening and closing of dispensary are well displayed. xix. The Drug dispensing counter has a single window. xx. Daily consumption of drug list is not being maintained
55. In patient Wards: xix. In the District Hospital all the 350 beds are functional. consists of three general ward one each for male and female and children. xx. The wards is attached with a nursing station xxi. The condition of beds was average. The beds were properly arranged. Next to each beds attendants stool, IV stand and bed side lockers were present. xxii. Diet was provided to the patients. Quality of food was found satisfactory.
xxiii. Waste management and infection control practices were found unsatisfactory.
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56. Operation Theater: xvii. We visited Operation Theatre of gynaecology section which is situated opposite to the District hospital. xviii. Running water facility is available in the operation Theatre xix. The necessary Equipment is available in the Operation Theatre. xx. Autoclave is available. xxi. Zoning of the Operation Theatre is not present. xxii. Emergency Drug Tray is present. xxiii. On the Drum that is Sterlized, the Date of sterilization is not present.
57. Labor room: xxxii. Due to over crouding the hygiene maintained in the labor room was unsatisfactory. xxxiii. Labor tables were in very bad condition.roof was not maintained. xxxiv. No screen/separation has been provided between delivery tables in labour room xxxv. There is risk of fumigation being missed out due to absence of record and schedule. This may lead to sepsis to the patients undergoing delivery and post partum infection to mother and/or neo -natal infections. xxxvi. Adequate power backup was present. xxxvii. Running water facility is available. xxxviii. The essential Tray for the Labor room was not present. xxxix. The Protocols of the Labor were not displayed. xl. New born corner functioning in improper ways. xli. Partition between labour tables not present. xlii. The eclampsia room has no provision of equipments and basic drugs and consumables, the staff using the same tray of Normal labour room.
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ANC Ward
58. Biomedical waste Management and Infection Control: xviii. Disposal system need be improve despite proper posters are displayed in the maximum places. xix. Color coded bins are being made available in all the departments xx. Disinfection through 1 % sodium chloride is not being practiced.
59. Immunization i. The people bring their children to the immunization room along with immunization card. DPT, Polio, Measles, and BCG are the vaccines administered by the nurse. ii. All the new born are not administered BCG, OPV Zero dose and Hepatitis 0 dose. iii. Record of immunization incomplete in the assigned column of delivery register.
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60. Laboratory Services i. The District Hospital has a in-house lab with provides all major tests ii. Proper display of user charges and available tests separately is needed near the lab. iii. The equipments and instruments in the lab are properly arranged. The lab has clear demarcated areas of collecting testing and reporting. iv. Adequate storage facilities are available. v. Infection control practices were found unsatisfactory vi. Regular AMC s of equipments is needed.
The following table details the laboratory services at the hospital. CLINICAL PATHOLOGY BIOCHEMISTRY Hematology :- Blood Sugar-Fasting, PP Hemoglobin estimation(Hb) Total Leukocyte count(TLC) Blood uric acid Differential Leukocyte count(DLC) Blood urea, blood cholesterol E.S.R. Triglycerides Blood group-ABO/RH Electolyte: Na+, Ca+ P.S. for type of Anemia Creatinine LFT SEROLOGY Protein-Total. Albumin, Globulin Pregnancy test (HCG) Billirubin Total WIDAL test SGOT SGPT VDRL test RAPID test Alkaline Phosphates RA Factor test Urine Analysis:- Semen Analysis:- Urine for Albumin, Sugar, Bile salts, Volume, Viscosity, Sperm count Bile pigments, Microscopy, Uroblinogen, acetone, specific gravity, Reaction (pH) Stool Analysis: - CSF Analysis:- Stool for Ova, Cyst, parasite, Appearance, Cell Count, DLC, Hanging drop for V. Cholera, Occult Malignant Cells, Proteins, Sugar, bllod, AFB. Others: Gram Stain, AFB Straining, Sputum AFB*3, Montoux test,
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61. Integrated Counseling and Testing Centre (ICTC) I. The hospital participates in the National AIDS Control Programme and has an ICTC center for the same. There are two counselors, a female at the ICTC centre/ room and a male counselor. II. There are insufficient testing kits to test all ANC cases. III. Lab technicians have shortage of hand globes, they are in risk. 16. USG room- The protocol not displayed, record keeping is also improper.sitting arrangement and toilet facility for pregnant women not adequet.
62. Medical Records a. New delivery register is not filled properly and completely. b. Immunization, JSY, referral and departure time/date not entered. c. There is no standared procedure to collect all data from different departments d. Jsy pending is there due to unaware about the guideline.
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1. Graphical Analysis
60.00 Infrastructure for ANC, Natal and PNC care 100.00
7.14 Knowledge & Skills Consumables and supplies 80.00 76.56
60.00
40.00 Maintenance of critical equipment and Reporting 42.86 infrastructure 20.00 25.00 0.00
Record & Maintenance Anti natal care services 75.86 60.00
Bio-Medical Waste Management Delivery or Natal Care Records
83.33 32.54 Post natal care 45.71
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1. ANC, Natal and PNC care- a. ANC chekup done by doctors is compromised, BP recording, Per abdomen examination no being performed to every PW b. Availability of infrastructure for ANC is good but not satisfactory for Natal services and PNC. c. Due to over load, space for delivery room, and post delivery and post operative room service really pathetic. d. Duty roster of delivery ward’s staff nurse is changing very frequently. e. Essential and specialty wise equipments and instruments were available in the examination rooms. f. Proper privacy maintain during ANC checkup. g. Running water and wash basin available. h. Light on examination table is not sufficient. i. Hygiene in delivery room and ward not maintain. j. SOPs not displayed in the labor room. k. The essential Tray for the Labor room was not adequet.
2. Consumables and supplies - a. Stocks of medicine supplies are sufficient. b. Stock book not updated completely.
3. Maintenance of critical equipment and infrastructure a. The Two Autoclave, 1 Baby wormer is functional. b. Some equipment in the laboratory is not maintained. c. No proper CMC plane for all critical equipments. d.
4. Bio-Medical Waste Management a. Improper disposal system in some places. b. Proper posters / IEC are not available in the many deparments. c. Colour coded bins are being made available in all the section
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5. Record & Maintenance and Reporting- a. New delivery not filled completely. Immunization, JSY payment, referral and discharge time has not been entering by in charge sister. b. Partograph not maintain . c. Validation of HMIS and E-mahatary report not being done by any one. 6. Knowledge & Skills a. SBA trained staff nurse not using the protocol of delivery room. b. Trained staff not practice as use of partograph and complication management. 7. Other key Observations
Other Key recommendations
7. The center should hold regular meeting of the Executive Committee of Jeevan Deep Samiti (which is not
been held) and make plan for effective utilization of the fund.
8. Much more pendency in the JSY payment, need to resolve the problem by pre singed check or by adding
one more signatory.
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