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Monitoring report of Bharatpur:

Dr.Iti Kaushik, Consultant, NRHM - I

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Contents:

Executive Summary…………………………………………………………

Abbreviations ……………………………………………………………….

District profile ………………………………………………………………

Introduction………………………………………………………………….

Health status of Bharatpur …………………………………………………

JSY……………………………………………………………………………

MCHN Day …………………………………………………………………..

District Hospital………………………………………………………………

Sikri CHC…………………………………………………………………….

Bayana CHC………………………………………………………………….

Sundrawali PHC……………………………………………………………...

Kethwada SC…………………………………………………………………

Damdama SC………………………………………………………………....

Annexure……………………………………………………………………..

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Executive summary:

The visit to Bharatpur was planned for accomplishing the goal of supportive supervision of the health facilities of high focused districts of Rajasthan. The central government has identified 12 district of Rajasthan as high focused and Bharatpur is one amongst the twelve. The visit planned on the dates of 23/June /2010 – 24/June/2010, keeping in mind the target of covering district hospital, two CHC, two PHC and two SC to have an idea of the existing health system of Bharatpur and the problems that are being faced on daily basis by the employees as well as by the general public.

The places visited during the visit are:

1. hospital

2. CHC - FRU

3. CHC –Sikri

4. PHC- Sundrawali

5. SC- Damdama

6. Model SC- Kaethwada

District hospital, Zanana hospital, Bayana CHC and Damdama SC were visited on the first day that is on 23/ June/ 2010 while Sikri CHC, Sundrawali PHC and Kethwada SC were supervised on 24/ June /2010. The reporting is done based on the formats given by the ministry and the detailed report of each facility is attached and the formats are attached as annexure in the end of the report.

There were some common observations made during the visit about the facilities visited and these were:-

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1. Human Rresource: There was a huge problem with the human resource at each facility. Mainly the facilities which have high patient load like CH, CHC etc suffered from severe shortage of manpower. 2. JSY: Every facility is facing the problem with JSY payments because of the system of account payee cheque by the Rajasthan government. 3. New born baby corner: There was not any provision of new born baby corner in the Labour room in most of the facilities. The warmers were also not present in most facilities. Attached toilets were not available with the labour room. Even the new constructions which are going on do not follow the norms of attached toilets etc. 4. Labour table: There is a provision of fixed labour table i.e. of cement or stone in Rajasthan which hampers the flexibility of moving the table if required or adjusting it to a comfortable level by the medical staff. 5. Training: The training levels in the district (SBA etc.) are not adequate as required. Moreover the people who are trained are not using their abilities and training effectively and efficiently. 6. Untied funds: The people do not know how to use the untied funds given to them for the betterment of the facility. The problem is more evident at the SC level where most of the untied fund is either not used or utilized only for filling up the pits in the village. 7. Most of the ANMs do not use haemoglobinometer for estimating Hb levels as they do not even know how to use it. 8. VHND: The MCHN day which was visited was not conducted properly. The ANM was not using the modalities given to her like BP apparatus, haemoglobinometer, weighing machine etc.

The problems faced by the facilities individually were discussed by the facility in charge, the BPM, the DPM and the concerned person. The details are discussed in the report.

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LIST OF ABBREVIATIONS

AMG Annual Maintenance Grants ASHA Accredited Social Health Activist AWW Anganwadi worker AYUSH Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homeopathy BEmONC Basic Emergency Obstetric & Neonatal Care BHW Basic health worker BPHC Block Primary Health Centre BMW Bio Medical Waste CEmONC Complicated Emergency Obstetric & Neonatal Care CH Civil Hospital CHC Community Health Centre DAM District Accounts Manager DH District Hospital DHA District Health Action Plans DGO Diploma in Gynecology & Obstetrics. DIO District Immunization Officer DPM District program manager DPMU District program management Unit EAG Empowered Action Group FP Family Planning FRU First Referral Unit HSC Health Sub Centre IFA Iron Folic Acid IMNCI Integrated Management of Neonates & Child Illness IMR Infant Mortality Rate IP In Patients IPD Inpatient Department IPHS Indian Public Health Standards JSK Jansankhya Sthirata Kosh JSY Janani Suraksha Yojana LBW Low Birth Weight LHV Lady Health Visitor MMR Maternal Mortality Ratio MMU Mobile Medical Unit MO Medical Officer MoHFW Ministry of Health and Family Welfare MPW Multipurpose Worker MTP Medical Termination of

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Pregnancy NFHS-3 National Family Health Survey - 3, 2005-06 NRC Nutritional Rehabilitation Centre NRHM National Rural Health Mission NSV Non Scalpel Vasectomy OP Out Patients OPD Out Patient Department ORS Oral Re-hydration Solution OT Operation Theatre PHC Primary Health Centre PWD Public Works Department RCH Reproductive and Child Health RKS Rogi Kalyan Samiti RTI/STI Reproductive Tract Infection/ Sexually Transmitted infection SC Sub Centre SNCU Sick New Born Care Unit UF Untied Funds

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District Bharatpur , Rajasthan

Introduction:

The visit to Bharatpur was planned for supportive supervision of the district as it has been identified as one of the 12 high focused districts of Rajasthan. The visit planned on the dates of 23/June /2010 – 24/June/2010, keeping in mind the target of covering district hospital, two CHC, two PHC and two SC to have an idea of the existing health system of Bharatpur and the problems that are being faced on daily basis by the employees as well as by the general public.

Bharatpur, Eastern gate of Rajasthan, is situated between 26° 22' to 27° 83' North Latitude and 76° 53' to 78° 17' East Longitude. It is situated 100 meters above the sea level. It is 184 km. away from Delhi in South-East. Northern Border of the district touches district Gurgaon of state Haryana, Eastern Border touches district Mathura, Southern Border touches district Agra of state Uttar Pradesh and district Dholpur of Rajasthan. It touches district Dausa in south-west and district Alwar in the North-West. It is easily accessible by road and train from these areas which make Bharatpur well linked to the developed cities like Delhi, Agra and Gurgaon.

The places visited during the visit are:

7. Bharatpur district hospital 8. CHC Bayana- FRU 9. CHC –Sikri 10. PHC- Sundrawali 11. SC- Damdama 12. Model SC- Kaethwada

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Administration: The region has following divisions for administrative purposes.

Number of Villages Sub Division Tehsil Habitat Inhabitat Total

Bayana Bayana 181 16 197

Roopwas Roopwas 148 16 164

Weir Weir 154 8 162

Bharatpur Bharatpur 185 21 206

Kumher 128 7 135

Nadbai 121 4 125

Deeg 130 12 142

Nagar Nagar 166 9 175

Kaman Kaman 119 13 132

Pahari Pahari 135 4 139

Total 10 10 1468 110 1578

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There are nine blocks in Bharatpur viz. Kumher, Deeg, Kaman, Nagar, Bayana, Nadbai, Roopwas, , Bharatpur city.

Health: Following health institutions delivers health services to the district

While the facilities that provide delivery services are the District Hospital, 13 CHCs, 30 PHCs & only 10 SCs.

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Health Facilities in Bharatpur:

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Janani Suraksha Yojana:

The Rajasthan government initiated the use of account payee cheque instead of bearer cheque for the beneficiaries, in view to provide the benefit to the actual beneficiaries i.e. the mother and the child. But this increased the problems for the general public especially for the BPLs as they generally do not have bank accounts. Moreover, the minimum balance requirement for an account is Rs. 1000 /- generally while according to the JSY scheme the amount given is Rs. 1400/- only to the rural population and Rs. 1000/- for the urban residents.

Each and every health facility of the district visited is facing the problem with JSY payments through account payee cheques. There is an example quoted in a local newspaper of of the problems faced by the beneficiaries due to this. The article of the newspaper reads as follows:

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However, on discussing the issue with the SPM of the state it has been observed that this situation arises due to lack of prior preparations before taking the orders of account payee cheques into action. But now the order has been withdrawn for the time being and attempts to overcome the problem. The actions which the state is now considering before making the JSY payment through account payee cheques again are:

ØThe provision of accounts for the beneficiaries on zero balance. For this the state government is trying to have tie ups with the banks. ØASHAs will be trained for helping the woman for opening the account at the time of 1st ANC registration.

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VHND/MCHN Day

The VHND is known as the MCHN day at Rajasthan. Most of the MCHN days held on Thursdays in Bharatpur. We have visited the MCHN at Sundrawali village of Bharatpur. It was being conducting in the Aganwadi center of the village. There were many shortfalls in the event and these were:

Ø The ANM was not using the haemoglobinometer for estimating the Hb levels and detecting the anemia. Ø The weighing machine was not in working condition. Ø The examination room was very dark and there was not any provision for light there. Ø The BP apparatus was not used by the ANM as it was kept in the locker.

The ANM was suggested to take care of all the above mentioned issues. She was encouraged to use haemoglobinometer to estimate the Hb levels and then declare any women anemic and for ruling out any type of hyper tension or hypo tension she should use BP apparatus.

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Yashodas

The Rajasthan government has initiated a new cadre of women workers known as Yashodas at district hospital and CHCs where the delivery load is higher. They serve as the helping hands to the ANMs. They provide emotional support to the pregnant lady at the time of labour and also make them aware of healthy practices such as breast feeding, hygiene maintenance of the lady as well as the newborn, the importance of immunization, family planning etc. The feedback of Yashodas from DH and CHCs was average. Some are working really very hard and fulfilling the purpose of their recruitments while at some places yashodas are not working up to expectations.

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Bharatpur District Hospital

Introduction:

The Bharatpur District hospital is located in the main city which is well connected by roads. It is a 258 beded hospital. There is separate hospital for women known as Zanana hospital. There is a huge shortage of manpower in the hospital especially for the Blood bank where 8 more technicians are required as there is heavy load on the department. There were two care takers at the district hospital. The post of hospital manager is vacant at the hospital.

Situational analysis:

The hospital gets 86 marks out of 120 (71%). The total score obtained by the district hospital depicts the situation of the hospital very effectively and the results can be shown with the help of graph as shown in the figure below:

This figure clearly depicts the picture of District hospital (based on the marks given by the visiting consultant). The infrastructure gets 21 marks out of 34 which suggest that the

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infrastructure of the district hospital was above average. The hospital acquires fewer marks in equipments in labour room and BMW management as there was absence of baby corner in the labour room etc. The OT has a very huge load and the fumigation of the OT done only 3 times a week. There are 7 X- ray machines in total present at the hospital. There was a trauma unit present at the hospital.

Shortfalls:

Ø There was a huge shortage of manpower at the hospital especially at the blood bank where at least 8 more technicians are required according to the staff working there. Ø CT scan machine was non functional since last 6 months. Ø The condition of the Burn ward at the hospital was vey miserable. The cooling mechanism of the ward was not effective. The staff of the ward was not giving proper attention to the patients as it was observed that the patient’s attendant was injecting the patient himself. Ø The JSY payments were affected because of the system of the account payee cheque to the beneficiaries by the state government. Ø The toilet was not attached to the labour room.

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SIKRI CHC

Introduction:

The Sikri CHC is a 30 bedded which is catering the population of approximately 17,000 – 18,000. The CHC is being renovated and major portion of the CHC was under construction. There are 4 M.B.B.S doctors in the CHC and the lady doctor who is responsible for conducting deliveries is not SBA trained. The average delivery load on the CHC is about 12 – 13 / day. Average OPD is about 100/day.

Situational Analysis:

The CHC gets a total of 63 out of 120 (52.5%). As the CHC was under construction at the time of visit, the infrastructure of the facility was not assessed properly. The JSY payments were not fulfilled adequately because of the norm of account payee cheque. Caesarean services were not available at the CHC because of the non availability of specialists at the facility. The total score obtained depicts the situation of the CHC very effectively and the results can be shown with the help of graph as shown in the figure below:

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Shortfalls:

Ø The system of account payee cheque to the beneficiaries of JSY was hampering the payments. Ø There was a huge shortage of human resource at the CHC. Ø Ambulance services are not available at the CHC. Ø Specialist doctors are not present at the CHC.

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CHC Bayana

Introduction:

CHC Bayana is located in block Bayana of Bharatpur. It is a designated FRU but not functional yet. The problem of shortage of human resource also exists with the CHC.

Situational Analysis:

The figure given below clearly depicts the situation of the CHC. There is a scope for improvement for every indicator in the CHC.

Shortfalls:

Ø There is a shortage of human resource in the CHC. Ø The BMW management needs to be taken care of. Ø The CHC is referred as FRU but it is not functional.

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Sundrawali PHC

Introduction:

The Sundrawali PHC is located in Nagar block of Bharatpur District. On the day of visit MO and the Ayurvedic doctor, both were not present. The population to which the PHC caters is approx. 6000. OPD rate is very low that is only 6-7 patients /day. The electrical supply to the PHC was not through proper connection while water supply was inadequate. The TB cards were not filled in properly (patient’s weight was not mentioned in any of the cards). JSY records were not maintained and some of them were stolen. There was 1 male nurse, 2 GNM, 1 ANM & 1 lab technician along with the MO and Ayurvedic physician. The laboratory was used only for card test (malaria) and even the basic tests were not performed at the PHC.

Situational Analysis:

The PHC gets only 19 marks out of 120 (15 %), based on the facility assessment format (attached as annexure). The performance of the PHC is below average. The total score obtained depicts the situation of the PHC very effectively and the results can be shown with the help of graph as shown in the figure below:

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Shortfalls:

Ø JSY payment records were not present at the PHC. Ø Expired medicines (oxytocin) were kept in the stores. Ø The doctors were not present at the PHC. Ø The lab was performing only the test for malaria. Even the general tests were not available in the facility. Ø The PHC was very low performing

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Damdama Sub Centre

Introduction:

Damdama SC is situated in the village Damdama and is near to & well connected to the Bayana CHC. The ANM does not stay at the SC as there is not any facility of electricity and water. The SC is built in a very large area and the building is very well built. Instead of good infrastucture the patient load at the SC is nil. The SC was closed at the time of visit. The ANM was called from her home to unlock the facility along with the second ANM. The ANM sits in the SC only for 1 – 2 hours a day. The only work that ANM does is to provide general medicines for cold and fever. The SC does not conducts delivery instead of a labour room present and the ANM SBA trained because there is shortage of water and electricity.

Situational Analysis:

The SC gets 28 marks total out of 100 (28 %) based on the facility assessment format. The performance of the SC is below average on the indicators of building condition, condition of toilets, services and performance and biomedical waste management. The total score obtained by the SC depicts the situation of the SC very effectively and the results can be shown with the help of graph as shown in the figure below:

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The figure clearly depicts the picture of the SC (based on the marks given by the visiting consultant). The building condition gets only 6 marks out of 25 because the ANM does not stay at the SC and there is not any provision of electricity and water at the SC. The SC has the sufficient area for its building and infrastructure. Moreover, the facility is built very well but is not used up to the expectations. Condition of toilets gets 2 marks out of 7 as the toilet was present at the SC but it was not usable due to absence of water. The services offered by the SC are very limited and performance of Damdama SC scored poor marks on the indicators i.e. only 20 out of 62. Services offered and timings were not displayed outside the SC, ANM does not stays at the SC, SC does not conducts deliveries, pregnant women and infant tracking register was not properly maintained etc. Om maintenance of BMW the SC gets 2 marks out of 6 because the color coded bins were not used accordingly and the pit was not present at the SC.

Short falls:

1. Electricity and water facilities were not available at the SC.

2. ANM does not stay at the sub centre.

3. Inspite of ANM being SBA trained the SC was not able to conduct deliveries.

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4. The SC is not fully functional and is very low performing instead of having good building and space.

5. The untied funds were used only for filling the pits in the village and not for any up gradation of SC.

Suggestions:

Ø The basic requirements like electricity, water etc. should be fulfilled for every facility.

Ø The ANM should be given a retraining of SBA and motivated to use the training and conduct deliveries at the facility.

Ø The ANM was suggested about how to make optimal use of untied funds.

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Kethwada SC (Bharatpur)

Introduction: The Kethwada SC is situated in Bharatpur and is a good performing Model SC. The ANM Mayadevi resides in the SC along with a newly appointed GNM. Population that is covered by the SC is 8,750 approx. Delivery rate at the SC is approx 30/month. There is a trend in Rajasthan that most couples opt for sterilization in winters (between Sept – Jan). In this SC the count of sterilization cases reaches approximately up to 14 -15 / month during this period. Most of the eligible couples use spacing methods in the village and are well aware of the benefits of using such methods. The ANM as well as the GNM were well aware of the use of NISCHAY kit and the ASHAs in the SC area also using the kit for detecting pregnancy.

Situational analysis:

The SC building was clean on the day of visit. The untied funds were used effectively for the up gradation of SC like for building and maintenance of boundary wall of the SC, for purchasing of some essential drugs & instruments etc. The total score obtained by the SC depicts the situation of the SC very effectively and the results can be shown with the help of graph as shown in the figure below:

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This figure clearly depicts the picture of Kethwada SC (based on the marks given by the visiting consultant). The building of the SC gets 11 marks out of 25 which show that there is a scope for improvement. Condition of toilets and sanitation needs some attention also although the maintenance of toilets is done effectively but the labour room do not have attached toilet. Problem of running water exist in the toilets also which affect the cleanliness and hygiene. Services provided by the SC and its performance gets 51 marks out of 62. As the ANM at the SC is well motivated and active so the services provided has less lacunas but still there is scope for improvement in some of the areas such as in pregnant women and infant tracking system, HMIS reporting, record keeping etc. The situation of biomedical waste management in the SC is satisfactory and the SC was fulfilling all the requirements that are necessary for the handling of biomedical waste like colour coded buckets were used, needle cutter was there in the working condition.

Shortfalls:

Ø The JSY payment method (account payee cheque) was major area for concern. Due to this the delivery rate at the SC was affected and the beneficiaries were also annoyed as they were not getting the benefit from the scheme. Ø Building of the SC needs proper maintenance with regards to electricity and water.

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Suggestion and problem faced by ANM:

The untied fund provided to the SC is less according to the need as the facility is a model SC and the load of deliveries and other patients is more as in comparison to the other SC. According to the ANM the SC should be provided by the additional fund as the SC requires some renovation

and additional instruments.

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Form D: Bharatpur District hospital

Name of the Consultant: Iti Kaushik Date & time : 23/ June/2010

District: Bharatpur Total marks: 125

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

I. Infrastructure

Item MOV Criteria Score Building a. Walls and floor and roof intact 1 condition b. Electrical wires not exposed 1 c. Electric switch boards not broken 1 d. Electric bulbs in wards / pathways / toilets 1 e. Whitewashed 1 f. Signage boards present 1 g. Rooms not dumped with condemned articles 0

Total marks = 6/7 Condition of a. Mosquito screens present and devoid of holes 0 wards b. Condemned articles not stored in the wards 0 c. window glasses not broken 1 d. Door / Screens / Curtains / present for ensuring

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privacy of patient 0 e. Availability of ceiling fans in wards 0 Total marks = 1/5 Water supply a. Running water available for 24 hours in Labour room 2 b. Running water available for 24 hours in OT c. Running water available for 24 hours in Toilets 2 d. Purified drinking water available for drinking for 0 patients in OP 0 e. Purified drinking water available for drinking for patients in IP 0 Total marks = 4/10 Condition of a. Doors are not damaged 1 toilets b. Floors are clean 1 c. Basins are not stained 1 d. water taps not damaged, 1 e. pathway is not dirty 1 f. Separate for male and female 1 Total marks = 6/6 Patient a. Seating arrangements are present in the OPD area 0 amenities b. Stools or chairs for attendants in the wards present 0 c. Inpatients are provided with blankets in winter 1 Total marks = 1/3 Furniture a. Cots are not rusted, not broken 1 b. Mattress not worn out, cloth not torn, cotton/coir not 1 coming out Total marks = 2/2

Drainage a. Drainage system not clogged 1

II. Services available (applicable for BPHCs and above)

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Sl.no Service Means of verification Score 1. 24 hour doctor available Duty roster, casuality register 2 2. 24 hour nurse available Duty roster, casuality register 2 3. 24 hour delivery services Delivery register 2 available 4. 24 hour newborn care Delivery register, Paediatric ward register, 2 services available Immunization register 5. 24 hour caesarean services Delivery register 2 (if FRU) 2 6. Tubectomy services available FP register 7. Safe abortion services MTP register 2 available 8. 24 hour blood transfusion Blood transfusion register / Blood bank master 2 services register 9. Laboratory Services Equipments and reagents for conducting the 2 tests are present, lab record shows tests are 1. Haemogram conducted 2. Sputum Examination 3. Lipid Profile Lab register 4. Hormone Assay 5. Urine Examination

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

13. Ambulance Records of operation [Number of ambulances, 2 average (if more than one ambulance) number of breakdowns in the last one week, number of drivers available per shift] maintained Total marks = 26/26 1. Functional telephone Telephone number with dial tone 1

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2. Adolescent sexual and OP register – number of adolescent 1 reproductive health services beneficiaries 3. Whether fixed day antenatal ANC register 1 clinics are conducted

4. Whether fixed day RTI/STI OPD Register 1 clinics are conducted 5. Whether fixed day Register 1 sterilization clinics are conducted 6. Whether IEC material 0 displayed

7 Public Display of JSY 0 Beneficiaries Total marks = 5/7

IV. Services Out-Sourced

Sl. Item Means of verification Score no 1. House a. Floor is cleaned with disinfectant on the day of visit 1 keeping b. rainbow linen colour maintained 0 c. OT fumigated 0 1 2. Generator a. Generator in working condition with designated horse power 1 b. Fuel for operation present 1 3. Food a. Food served to inpatients 1 b. Food chart for inpatients Total marks = 5/7

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V) Equipments and supplies

Item MOV condition Score Trolley a. In working condition b. Trolley without rust 1

Wheelchair a. In working condition 1 b. Wheelchair without rust

Stretcher a. Stretcher without rust b. not broken 1 Total marks = 3/3 Sterilised gloves Sterilised gloves available 1 Average number of OP drugs available Drug stock register 2 (monthly) Availability of life saving drugs present Availability of; 2

a. Oxytocin b. Misoprostol c. Magnesium Sulphate d. IV antibiotics

VI. Equipments in Labour room

Equipment MOV Score 1. Spot light in labour room 1 2. Vacuum extractor 1 1 3. Resuscitation equipment for newborn – Bag and mask 4. Resuscitation equipment for newborn – Laryngoscope and full set of 1 endo-tracheal tubes

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5. Baby resuscitation table with infant warmer 6. Mucous sucker 0 7. Baby weighing machine 0 8. Partograph 1 0 9. Privacy in Labour room (curtains etc)

10. Toilet attached to Labour room 0

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

12. Labour board not rusted, not broken and not blood stained 0 Total marks = 6/12

VII)Equipments in OT

Equipments MOV score 1. Ceiling OT light/ Floor OT light (shadowless) 1 2. Oxygen cylinder 1 3. Boyles apparatus (only FRU) 1 4. Suction apparatus 1 1 5. Adequate quantity of linen 1 6. Spinal anaesthesia set (FRU) 1

7. Ante room present 0 Total marks = 6/7

VIII)Bio-medical Waste Management

1 3 sets of linen per surgery per day. (Calculate average number of surgeries per Day )

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Item MOV Score Waste a. Colour coded buckets used 1 management b. Deep burial pit available where anatomical waste is 1 disposed 1 c. Needle cutter in working condition 0 d. no mix of infectious or non-infectious waste done e. waste bins not overfilled 0 f. needles and syringes mutilated and disinfected before 0 putting in waste bin 0 g. metal sharps disposed in puncture proof containers 1 h. disposable gloves and masks not reused Total marks = 4/8

IX) Central sterilization unit

MOV Score Autoclave a. Functioning autoclave 1 b. Usage of signalac tape c. usage of biological indicator d. swab test of sterile packs 1 Total marks = 2/2

X) Records and reports

Item MOV score Separate column (in delivery register) for recording major complications leading to maternal death 0 Delivery register mentions about the details of the baby and condition of the 0 mother 1 Referral slips are issued to patients Total marks=1/3

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XI) Finance

Head Number of mothers yet to receive the JSY money Score

RKS Full utilization of funds in 2009-10 2 JSY JSY payments not pending till last week of the visit 0 Total marks = 2/4

Appendix 1

Inspection scoring sheet for health facilities

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

District: Total marks: 125

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

Item Maximum Facility marks Score Infrastructure 34 21 Services available (applicable for BPHCs and 33 31 above) Services Out-Sourced 7 5 Equipments and supplies 10 8 Equipments in Labour room 12 6 Equipments in OT 7 6 Bio-medical Waste Management 8 4 Central sterilization unit 2 2 Records and reports 3 1 Finance 4 2 Total Score 120 86

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Form D: Bayana CHC

Name of the Consultant: Iti Kaushik Date & time : ......

District: Bharatpur Total marks: 125

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

III. Infrastructure

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

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Total marks = 2/5 Water supply Running water available for 24 hours in Labour room 2 Running water available for 24 hours in OT Running water available for 24 hours in Toilets 2 Purified drinking water available for drinking for patients 0 in OP 0 Purified drinking water available for drinking for patients 0 in IP Total = 4/10 Condition of Doors are not damaged 1 toilets Floors are clean 1 Basins are not stained 0 water taps not damaged, 0 pathway is not dirty 0 Separate for male and female 1 Total = 3/6 Patient amenities Seating arrangements are present in the OPD area 1 Stools or chairs for attendants in the wards present 0 Inpatients are provided with blankets in winter 1 Total = 2/3 Furniture Cots are not rusted, not broken 0 Mattress not worn out, cloth not torn, cotton/coir not 1 coming out Total = 1 / 2

Drainage Drainage system not clogged 1

IV. Services available (applicable for BPHCs and above)

Sl.no Service Means of verification Score 1. 24 hour doctor available Duty roster, casuality register 2 2. 24 hour nurse available Duty roster, casuality register 2 3. 24 hour delivery services Delivery register 0 available 4. 24 hour newborn care Delivery register, Paediatric ward register,

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services available Immunization register 2 5. 24 hour caesarean services Delivery register 0 (if FRU)

6. Tubectomy services available FP register 2 7. Safe abortion services MTP register available 0 8. 24 hour blood transfusion Blood transfusion register / Blood bank master services register 0 9. Laboratory Services Equipments and reagents for conducting the tests are present, lab record shows tests are conducted 6. Haemogram 7. Sputum Examination Lab register 8. Lipid Profile 9. Hormone Assay 10. Urine Examination 1

10. Availability of ECG Facility ECG machine available & working 2 11. X Ray Facility with X-ray X ray register – working status 1 Technician available 12. Ultrasound services available USG register – working status 1 13. Ambulance Records of operation [Number of ambulances, average (if more than one ambulance) number of 2 breakdowns in the last one week, number of Total = drivers available per shift] maintained 15/ 26

1. Functional telephone Telephone number with dial tone 1 2. Adolescent sexual and OP register – number of adolescent beneficiaries 1 reproductive health services 1 3. Whether fixed day antenatal ANC register clinics are conducted 4. Whether fixed day RTI/STI OPD Register 0 clinics are conducted 5. Whether fixed day Register 0

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sterilization clinics are conducted 0 6. Whether IEC material displayed

7 Public Display of JSY 0 Beneficiaries Total = 3/7

Services Out-Sourced

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

OT fumigated 0 2. Generator Generator in working condition with designated horse power 1

Fuel for operation present 0 3. Food Food served to inpatients 0 Total = Food chart for inpatients 2/7

V) Equipments and supplies

Item MOV condition Score

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Trolley In working condition Trolley without rust 1 Wheelchair In working condition Wheelchair without rust 0 Stretcher Stretcher without rust 1 not broken Total = 2/3

Sterilised gloves Sterilised gloves available 1 Average number of OP drugs Drug stock register 2 available (monthly) Availability of life saving drugs Availability of; Oxytocin Misoprostol Magnesium 2 present Sulphate IV antibiotics

VII. Equipments in Labour room

Equipment MOV Score Spot light in labour room 1 Vacuum extractor 0 Resuscitation equipment for newborn – Bag and mask 1 Resuscitation equipment for newborn – Laryngoscope and full set of endo- 0 tracheal tubes Baby resuscitation table with infant warmer 1 1 Mucous sucker 1 Baby weighing machine 0 Partograph 1 Privacy in Labour room (curtains etc)

Toilet attached to Labour room

Protocols displayed: Active management of 3rd stage of labour (also check case 0

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sheets)

Labour board not rusted, not broken and not blood stained 0 Total = 6/ 12

VII) Equipments in OT

Equipments MOV score Ceiling OT light/ Floor OT light (shadowless) 0 Oxygen cylinder 1 Boyles apparatus (only FRU) 0 Suction apparatus 1 2 Adequate quantity of linen 1 Spinal anaesthesia set (FRU) 0 Ante room present 0 Total = 3/7

VIII)Bio-medical Waste Management

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

2 3 sets of linen per surgery per day. (Calculate average number of surgeries per Day )

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Total: 4/ 8

IX) Central sterilization unit

MOV Score Autoclave e. Functioning autoclave f. Usage of signalac tape g. usage of biological indicator Total =1 / 2 marks h. swab test of sterile packs

X) Records and reports

Item MOV score Separate column (in delivery register) for recording major complications leading 1 to maternal death Delivery register mentions about the details of the baby and condition of the 0 mother

Referral slips are issued to patients 1 Total = 2/3

XI) Finance

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Head Number of mothers yet to receive the JSY money Score

RKS Full utilization of funds in 2009-10 1 JSY JSY payments not pending till last week of the visit 0 Total = 1 / 4

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Appendix 1

Inspection scoring sheet for health facilities

Name of the inspecting officer: Iti kaushik Date & time: ......

District: Bharatpur Total marks: 125

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

Item Maximum Facility Score marks Infrastructure 34 17 Services available (applicable for BPHCs and above) 33 18

Services Out-Sourced 7 2 Equipments and supplies 10 7 Equipments in Labour room 12 6 Equipments in OT 7 3 Bio-medical Waste Management 8 4 Central sterilization unit 2 1 Records and reports 3 2 Finance 4 1 Total Score 120 61

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Form D: Sikri CHC

Name of the Consultant: Iti Kaushik Date & time: ......

District: Bharatpur Total marks: 125

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

V. Infrastructure

Item MOV Criteria Score Building Walls and floor and roof intact 1 condition Electrical wires not exposed 1 Electric switch boards not broken 1 Electric bulbs in wards / pathways / toilets 1 Whitewashed 1 Signage boards present 0 Rooms not dumped with condemned articles 0

Total marks = 5/7 Condition of Mosquito screens present and devoid of holes 0 wards Condemned articles not stored in the wards 0 window glasses not broken 0 Door / Screens / Curtains / present for ensuring/privacy of patient 0 Availability of ceiling fans in wards 1 Total marks = 1/5 Water supply Running water available for 24 hours in Labour room 2 Running water available for 24 hours in OT 2 Running water available for 24 hours in Toilets 2 Purified drinking water available for drinking for patients in OP 0 Purified drinking water available for drinking for patients in IP 0 Total marks

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= 6/10 Condition of Doors are not damaged 1 toilets Floors are clean 1 Basins are not stained 0 water taps not damaged, 0 pathway is not dirty 0 Separate for male and female 1 Total marks = 3/6 Patient Seating arrangements are present in the OPD area 0 amenities Stools or chairs for attendants in the wards present 1 Inpatients are provided with blankets in winter 1 Total marks = 2/3 Furniture Cots are not rusted, not broken 1 Mattress not worn out, cloth not torn, cotton/coir not coming 1 out Total marks = 2/2 Drainage Drainage system not clogged 1

VI. Services available (applicable for BPHCs and above)

Sl.no Service Means of verification Score 1. 24 hour doctor Duty roster, casuality register 2 available 2 2. 24 hour nurse Duty roster, casuality register available 0 0 3. 24 hour delivery Delivery register services available 0 4. 24 hour newborn care Delivery register, Paediatric ward register, services available Immunization register 2 5. 24 hour caesarean Delivery register services (if FRU)

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6. Tubectomy services FP register 0 available 7. Safe abortion services MTP register 0 available 8. 24 hour blood Blood transfusion register / Blood bank master transfusion services register 9. Laboratory Services Equipments and reagents for conducting the tests are 1 Haemogram present, lab record shows tests are conducted Sputum Examination Lipid Profile Lab register Hormone Assay Urine Examination 1 10. Availability of ECG ECG machine available & working 0 Facility 11. X Ray Facility with X- X ray register – working status 1 ray Technician available 1 12. Ultrasound services USG register – working status Total available marks = 13. Ambulance Records of operation [Number of ambulances, average 10/26 (if more than one ambulance) number of breakdowns in the last one week, number of drivers available per shift] maintained

1. Functional telephone Telephone number with dial tone 1 2. Adolescent sexual OP register – number of adolescent beneficiaries 1 and reproductive health services 0 3. Whether fixed day ANC register antenatal clinics are 0 conducted 4. Whether fixed day OPD Register 1 RTI/STI clinics are conducted

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5. Whether fixed day Register 1 sterilization clinics are conducted 0 Total 6. Whether IEC material marks = displayed 4/7 7 Public Display of JSY Beneficiaries

V. Services Out-Sourced

Sl. Item Means of verification Score no 1. House Floor is cleaned with disinfectant on the day of visit 1 keeping rainbow linen colour maintained 0 OT fumigated 0 0 2. Generator Generator in working condition with designated horse 1 power 1 Fuel for operation present 1 3. Food Food served to inpatients Total marks = Food chart for inpatients 4/7

V) Equipments and supplies

Item MOV condition Score Trolley In working condition 1 Trolley without rust Wheelchair In working condition 1 Wheelchair without rust Stretcher Stretcher without rust 1 not broken Total marks

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= 3/3 Sterilised gloves Sterilised gloves available 1 Average number of OP drugs Drug stock register 3 available (monthly) Availability of life saving drugs Availability of; Oxytocin, Misoprostol 2 present Magnesium Sulphate ,IV antibiotics

VIII. Equipments in Labour room

Equipment MOV Score 13. Spot light in labour room 1 14. Vacuum extractor 1 1 15. Resuscitation equipment for newborn – Bag and mask 16. Resuscitation equipment for newborn – Laryngoscope and full set of 0 endo-tracheal tubes 17. Baby resuscitation table with infant warmer 0 1 18. Mucous sucker

19. Baby weighing machine 1 20. Partograph 0 0 21. Privacy in Labour room (curtains etc)

22. Toilet attached to Labour room 0

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

24. Labour board not rusted, not broken and not blood stained 0

Total marks = 5/12

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VII) Equipments in OT

Equipments MOV score 8. Ceiling OT light/ Floor OT light (shadowless) 1 9. Oxygen cylinder 1 0 10. Boyles apparatus (only FRU) 11. Suction apparatus 1 3 12. Adequate quantity of linen 1 13. Spinal anaesthesia set (FRU) 0 14. Ante room present 0 Total marks = 4/7

VIII) Bio-medical Waste Management

Item MOV Score Waste Colour coded buckets used 1 management Deep burial pit available where anatomical waste is 0 disposed 1 Needle cutter in working condition 0 no mix of infectious or non-infectious waste done waste bins not overfilled 0 needles and syringes mutilated and disinfected before 1 putting in waste bin 0 metal sharps disposed in puncture proof containers 1 disposable gloves and masks not reused Total marks = 4/8

IX) Central sterilization unit

MOV Score Autoclave Functioning autoclave 1

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

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Usage of signalac tape 0 usage of biological indicator swab test of sterile packs Total = 1/2

X) Records and reports

Item MOV score Separate column (in delivery register) for recording major complications 0 leading to maternal death Delivery register mentions about the details of the baby and condition of the 0 mother

Referral slips are issued to patients 1 Total marks = 1/3

XI) Finance

Head Number of mothers yet to receive the JSY money Score

RKS Full utilization of funds in 2009-10 1 JSY JSY payments not pending till last week of the visit 0 Total marks = 1 / 4

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Appendix 1

Inspection scoring sheet for health facilities

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

District: Total marks: 125

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

Item Maximum marks Facility Score Infrastructure 34 20 Services available (applicable for BPHCs and above) 33 14

Services Out-Sourced 7 4 Equipments and supplies 10 9 Equipments in Labour room 12 5 Equipments in OT 7 4 Bio-medical Waste Management 8 4 Central sterilization unit 2 1 Records and reports 3 1 Finance 4 1 Total Score 120 63

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Form D: Sundrawali PHC

Name of the Consultant: Iti Kaushik Date & time: 24/June/2010

District: Bharatpur Total marks: 125

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

1. No. of Doctors (with details of specialists available): 2 (1 MBBS & 1 Ayurvedic) 2. No. of Nurses: Posted:1 male nurse, 2 GNM 3. No. of ANM’s: Posted: 1 4. Lab technician : 1

Infrastructure

Item MOV Criteria Score Building Walls and floor and roof intact 1 condition Electrical wires not exposed 0 Electric switch boards not broken 0 Electric bulbs in wards / pathways / toilets 0 Whitewashed 0 Signage boards present 0 Rooms not dumped with condemned articles 0 Total marks = 1/7 Condition of Mosquito screens present and devoid of holes 0 wards Condemned articles not stored in the wards 0 window glasses not broken 1 Door / Screens / Curtains / present for ensuring privacy of 0 patient Availability of ceiling fans in wards 0 Total marks = 1/5 Water supply Running water available for 24 hours in Labour room 2 Running water available for 24 hours in OT 0 Running water available for 24 hours in Toilets 0 Purified drinking water available for drinking for patients in 0 OP Purified drinking water available for drinking for patients 0 in IP

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Total marks = 2/10

Condition of Doors are not damaged 1 toilets Floors are clean 0 Basins are not stained 0 water taps not damaged, 1 pathway is not dirty 0 Separate for male and female 1 Total marks = 3/6 Patient Seating arrangements are present in the OPD area 0 amenities Stools or chairs for attendants in the wards present 1 Inpatients are provided with blankets in winter 0 Total marks = 1/3 Furniture Cots are not rusted, not broken 1 Mattress not worn out, cloth not torn, cotton/coir not 0 coming out Total marks = 1 / 2 Drainage Drainage system not clogged 1

VII. Services available (applicable for BPHCs and above)

Sl.no Service Means of verification Score 1. 24 hour doctor Duty roster, casuality register 0 available 2 2. 24 hour nurse Duty roster, casuality register available 0 3. 24 hour delivery Delivery register 0 services available

4. 24 hour newborn care Delivery register, Paediatric ward register, 0 services available Immunization register 0 5. 24 hour caesarean Delivery register 0 services (if FRU)

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6. Tubectomy services FP register available 7. Safe abortion services MTP register 0 available 8. 24 hour blood Blood transfusion register / Blood bank master register transfusion services 9. Laboratory Services Equipments and reagents for conducting the tests are 0 Haemogram present, lab record shows tests are conducted Lab Sputum Examination register Lipid Profile Hormone Assay Urine Examination 0 10. Availability of ECG ECG machine available & working Facility 0 11. X Ray Facility with X- X ray register – working status 0 ray Technician available 12. Ultrasound services USG register – working status 0 available Total 13. Ambulance Records of operation [Number of ambulances, average marks = (if more than one ambulance) number of breakdowns 2/26 in the last one week, number of drivers available per shift] maintained 1. Functional telephone Telephone number with dial tone 1 2. Adolescent sexual OP register – number of adolescent beneficiaries 0 and reproductive health services 0 3. Whether fixed day ANC register antenatal clinics are 0 conducted 4. Whether fixed day OPD Register RTI/STI clinics are 0 conducted 5. Whether fixed day Register

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sterilization clinics are 0 conducted 0 6. Whether IEC material Total displayed marks = 7 Public Display of JSY 1 / 7 Beneficiaries Services Out-Sourced Sl. Item Means of verification Score no 1. House Floor is cleaned with disinfectant on the day of visit 0 keeping rainbow linen colour maintained 0 OT fumigated 0 2. Generator Generator in working condition with designated horse 0 power 0 Fuel for operation present 0 3. Food Food served to inpatients 0 Food chart for inpatients Total marks = 0 / 7

Equipments and supplies

Item MOV condition Score Trolley In working condition 1 Trolley without rust Wheelchair In working condition 0 Wheelchair without rust Stretcher Stretcher without rust not broken 1 Total marks = 1 / 3 Sterilised gloves Sterilised gloves available 0 Average number of OP drugs Drug stock register 0 available (monthly) Availability of life saving drugs Availability of; Oxytocin ,Misoprostol 0 present ,Magnesium Sulphate ,IV antibiotics

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]

Equipments in Labour room

Equipment MOV Score Spot light in labour room 0 Vacuum extractor 0 Resuscitation equipment for newborn – Bag and mask 0 Resuscitation equipment for newborn – Laryngoscope and full set of endo- 0 tracheal tubes Baby resuscitation table with infant warmer 0 Mucous sucker 0 Baby weighing machine 1 Partograph 0 Privacy in Labour room (curtains etc) 0 Toilet attached to Labour room

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

Labour board not rusted, not broken and not blood stained 0

Equipments in OT

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Equipments MOV score Ceiling OT light/ Floor OT light (shadowless) 0 Oxygen cylinder 0 Boyles apparatus (only FRU) 0 Suction apparatus 0 4 Adequate quantity of linen 0 Spinal anaesthesia set (FRU) 0 Ante room present 0 Total marks = 0/7

Bio-medical Waste Management

Item MOV Score Waste Colour coded buckets used 0 management Deep burial pit available where anatomical waste is 0 disposed 1 Needle cutter in working condition 0 no mix of infectious or non-infectious waste done waste bins not overfilled 0 needles and syringes mutilated and disinfected before 1 putting in waste bin 0 metal sharps disposed in puncture proof containers 1 disposable gloves and masks not reused Total marks = 3/8

Central sterilization unit

MOV Score Autoclave Functioning autoclave 0 Usage of signalac tape usage of biological indicator 0 swab test of sterile packs

4 3 sets of linen per surgery per day. (Calculate average number of surgeries per Day )

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Total marks = 0/2

Records and reports Item MOV score Separate column (in delivery register) for recording major complications leading to maternal death 1 Delivery register mentions about the details of the baby and condition of the 0 mother

Referral slips are issued to patients 0 Total marks = 1/3

Finance Head Number of mothers yet to receive the JSY money Score

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

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Appendix 1

Inspection scoring sheet for health facilities

Name of the inspecting officer: Iti Kaushik Date & time: ......

District: Bharatpur Total marks: 125

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

Item Maximum Facility marks Score Infrastructure 34 10 Services available (applicable for BPHCs and 33 3 above) Services Out-Sourced 7 0 Equipments and supplies 10 1 Equipments in Labour room 12 1 Equipments in OT 7 0 Bio-medical Waste Management 8 3 Central sterilization unit 2 0 Records and reports 3 1 Finance 4 O Total Score 120 19

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Inspection format for SHCs

Name of the inspecting officer: Iti Kaushik Date & time: 24/June/2010

District: Bharatpur Total marks: 90

Location of Facility: Kethwada Building: Govt.

Stay in the SHC – Yes

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

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

Electricity available

Item MOV Criteria Score Building condition Walls and floor and roof intact 2 Electrical wires not exposed 0 Electric switch boards not broken 0 Whitewashed 2 overhead tank and running water 0 available electricity available 0 floor is clean on the day of visit 2 ANM stay in the SHC 5 Total – 11/25 marks Condition of toilets Doors are not damaged 2 Floors are clean & Basins are not 2 stained Running water present 0

Total- 4 / 7 Services & performance Services offered and timings displayed 5 Pregnant women and infant tracking register maintained 2 Micro plan for VHNDs available; at least 90% of planned VHNDs held in the last 2 quarter

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Item MOV Criteria Score Nischay kit available Kit A and B available* 2 Delivery kit available (at least 2) 2 2 Weighing machine (mother / baby) and 2 BP apparatus (and stethoscope) available Hb estimations done 2 Male worker present 0 Records of vector control activities 0 undertaken present (spraying, blood slides etc.) HMIS/IDSP formats getting reported 0 ANM stays in the SHC 10 SHC conducts deliveries 10 The ANM is SBA trained 5 2nd ANM present 5 Immunization cards updated 2 Total – 51/62 Biomedical Waste Colour coded buckets used 2 2 Management Deep burial pit available where anatomical waste is disposed (if the SHC conducts deliveries) 2 Needle cutter in working condition Total – 6/6 *Look for paracetamol and cotrimoxazole

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Appendix 1

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

Name of the inspecting officer: Iti Kaushik Date & time: 24/June/2010

District: Bharatpur Total marks: 100

Location of the SHC:

Item Maximum score SHC score

Building condition 25 11

Condition of toilets 7 4

Services & performance 62 51

Biomedical Waste Management 6 6

Total Score 100 72

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Form E: Damdama Sub Centre

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

Name of the inspecting officer: Iti Kaushik Date & time: ......

District: Bharatpur Total marks: 90

Location of Facility: Damdama Village Building: Govt.

Stay in the SHC – No If no place of residence & distance form SHC -- 5 km

SBA trained yes Deliveries not conducted at SC (mostly goes to Bayana CHC)

Electricity & water : No

Item MOV Criteria Score Building condition Walls and floor and roof intact 2 Electrical wires not exposed 0 Electric switch boards not broken 0 Whitewashed 2 overhead tank and running water 0 available electricity available 0 floor is clean on the day of visit 2 ANM stay in the SHC 0 Total – 6 / 25 Condition of toilets Doors are not damaged 2 Floors are clean & Basins are not 0 stained Running water present 0 Total = 0/7 Services & performance Services offered and timings displayed 0 Pregnant women and infant tracking register maintained 0 Micro plan for VHNDs available; at least 90% of planned VHNDs held in the last 2 quarter

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Item MOV Criteria Score Nischay kit available Kit A and B available* 2 Delivery kit available (at least 2) 2 Weighing machine (mother / baby) and 0 BP apparatus (and stethoscope) 2 available Hb estimations done Male worker present 0 Records of vector control activities 0 undertaken present (spraying, blood 0 slides etc.) HMIS/IDSP formats getting reported ANM stays in the SHC 0 SHC conducts deliveries 0 The ANM is SBA trained 0 2nd ANM present 5 Immunization cards updated 5 2 Total – 20 / 62 marks Biomedical Waste Colour coded buckets used 0 Deep burial pit available where 0 Management anatomical waste is disposed (if the SHC conducts deliveries) Needle cutter in working condition 2 Total – 2 / 6 marks *Look for paracetamol and cotrimoxazole

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Appendix 1

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

Name of the inspecting officer: Iti Kaushik Date & time: ......

District: Bharatpur Total marks: 100

Location of the SHC: Bayana Block

Item Maximum score SHC score

Building condition 25 6

Condition of toilets 7 2

Services & performance 62 20

Biomedical Waste Management 6 2

Total Score 100 28

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Form A: Supportive Supervision Form Yearly Monitoring Format Name of Consultant: Iti Kaushik

Name of the District and State: - BHARATPUR (RAJASTHAN)

Date: 23/June/2010 – 24/June/2010 Infrastructure:

DH CHCs BPHCs PHCs APHCs/ HSC NPHC’s Blocks Population 1. KUMHER 175418 02 09 57 2.DEEG 195721 02 05 36 3.KAMAN 157766 01 05 40 4.NAGAR 195671 02 5.BAYANA 225348 01 01 06 6.NADBAI 182760 01 04 01 7.ROOPWAS 211147 02 04 02 8.BHUSAWAR 237261 02 13 41 9.BHARATPUR 322876 1 0 0 0 2 CITY Total (In Position) 1 13 9 37 0 396 Total Functional 1 13 9 37 0 396 Total Functional (providing 1 13 0 30 0 10 delivery services) Target for - - - - - 60 New Constructions (2010-11) Target for - - - 7 - 100 Operationlization Number of new constructions - - - - - 60 (PHC, CHC etc) initiated before April 2008 and not yet completed. Number of major civil works ------initiated (construction of labour rooms, wards etc. In existing premises) before April 2009 and not yet completed.

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Facility 2009-10 In position Target 2010-2011 SNCU 1 1 Stabilization Unit (CHC/BPHC) 0 7

Human resources available in the district State: As on month______2010 District: Category Regular Contractual Total Require Shortfall Target Sancti In Sanctio In availa d for the 2010-11 oned position ned position ble existing post (availab post (availab facilities le le * Mid wives ANM 490 459 LHV 52 50 PHN - - Nurse 222 221 Total Other technical Health workers [male] Lab technician 75 74 Pharmacist Radiographer 08 08 Total Medical MO/GDMO 100 86 Specialist Obstetrics “ paediatrics “ anaesthesia Surgery Medicine Opthalmology Total *Also analyse requirements as per services provided by the facilities qualitatively

H.R performance Data (District level) No. Of OPD cases per doctor in the district 27 No of Obstetricians performing C.Sections out of Total available 6 Number of C-sections performed per obstetrician at Level 3 facility -

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No of Ophthalmologists performing Cataract Surgeries out of Total available 2 Number of cataract surgeries performed per ophthalmologist 19 No. of LSAS trained personnel providing services 7 No. of EmOC trained personnel providing services 7 Percentage of deliveries performed by SBA trained personnel’s {[( deliveries performed by SBA trained personals / total number of deliveries]*100} Number of deliveries performed per SBA 11 Average number of outpatient cases seen by the mobile medical unit (MMU) 909

Training Activity / Measurable indicator 2009-10 Target 2010-2011 Percentage of ANMs trained as SBAs 30% 30% (SBA trained ANMs/Total Number of ANM*100) Percentage of nurses trained as SBAs 11 20 (SBA trained nurses/Total Number of nurses *100) Number of Doctors trained on EmOC 7 2 Number of Doctors trained on LSAS 7 2 Number of Doctors trained in NSV/ 7 2 Conventional vasectomy Number of Doctors trained in Abdominal - 2 Tubectomy (Minilap) Number of Doctors trained in Laproscopic - - Tubectomy Number of Personnel trained in FIMNCI - - Number of ASHAs completed four modules of 0 1493 training

Financial Indicators Percent expenditure of funds through Non Governmental Organization (NGO) 4.36% Number of facilities with less than 50% utilization of the untied grants (BPHC 114 and above) Percentage of JSY payments pending as on 31 March 2010 (with regards to 0 institutional deliveries in the public facilities only)

Indicators Activity / Measurable indicator 2009-10 Target 2010- 2011

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Deliveries 1. Total expected 53,900 61,600 2. Total Reported 45572 6955 a. Institutional 45572 5955 b. Home SBA 9666 NA c. Home Non SBA 1196 NA 3. Total Unreported (1-2) 8328 NA 4. Percentage of Institutional Deliveries 59.18% 59.18% {[(Institutional/total expected)]*100} 5. Percentage of C- sections performed (w.r.t - institutional deliveries): {[(no. of C section performed/ institutional deliveries)]*100)} 6. Percentage of C- sections performed (w.r.t. - expected deliveries: {[(no. of C section performed / expected deliveries)]*100)} 7. Percentage of maternal complication (medical - and surgical)treated against total institutional deliveries {[( maternal complication treated / institutional deliveries)]*100)} 8. Percentage of maternal complication (medical - and surgical) treated (w.r.t. expected deliveries): {[(no. of maternal complication treated / expected deliveries)]*100)} 9. High risk pregnancies identified {[(no. of high 5.25% risk pregnancies identified / No. Of ANC registered)]*100)} Percentage of pregnant women tracked 94.69% Percentage of fully immunized children 90.21% Family Planning 1. Male sterilisation (in numbers) 83 2. Female Sterilization 9609 3. No. of IUD insertion No. Of Facilities providing safe abortion services* 8 Disease control Case Detection Rate of TB among new sputum positive 56% patients Treatment Success Rate among new sputum positive 65% patients initiated on DOTS ABER for Malaria API for Malaria No. of Reconstructive surgeries performed under NLEP Annual New Case Detection Rate for Leprosy

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*Explore qualitatively the methods of safe abortion used

Service Delivery Percentage of Medical camps conducted against planned {[medical camps 98% conducted/medical camps planned]*100} Percent of VHNDs conducted against planned 59.28%

Number of functional Mobile Medical Units (MMU)5 01

Other Indicators Is community based monitoring system existent in the district? (Yes / no ) NO Percent of data elements uploaded in last quarter of 2009-10 53% Percentage of functional/ working ILR points6 97% {[number of functional ILR points]/ [number of total ILR points]}*100 Qualitative explore plan for inaccessible areas [in details] YES

* Following this is the RCH sub plan for the district.

5 Analyze as per state policy 6 ILR : Ice Line Refrigerator

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Form B: Supportive Supervision Form

Quarterly Monitoring Format

Name of Consultant: Iti Kaushik

Name of the District and State : - BHARATPUR (RAJASTHAN)

Date: 23/June/2010 – 24/June/2010

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

Infrastructure DH CHCs BPHCs PHCs APHCs/ HSC NPHCs New constructions 0 0 - 0 0 60 initiated Major Civil Works 0 0 - 0 0 - 1.Initiated 0 0 - 2 0 50 2.competed 0 0 - 2 0 08

Facility Target Q I Q II Q III Q IV 2010-2011 SNCU 01 01 01 01 01 Stabilization Unit (CHC/BPHC) 07 07 07 07 07 Functional Mobile Medical Units (MMU)7 01 01 01 01 01

Human resources: New Recruitments in the district State: As on month______2010 District: Category Target 2010- New New 11 recruitment 11recruitmen [regular] t [contractual] Mid wives - - -100 ANM 100 - -

7 Analyze as per DHAP

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LHV - - - PHN - - - Nurse - - - Total - - - Health workers [male] - - - Lab technician - - - Pharmacist 0 - 0 Radiographer 0 - 0 Total 0 - 0 MO/GDMO 0 - 0 Specialist Obstetrics 01 - 01 “ paediatrics 0 - 0 “ anaesthesia 0 - 0 Surgery 0 - 0 Medicine 0 - 0 Ophthalmology 0 - 0 Total 01 - 01

H.R performance Data (District level) Indicator Last Cumulative from Quarter April 2010 till previous month of the visit No. Of OPD cases per doctor in the district 29 31 No of Obstetricians performing C.Sections out of Total 7 8 available Number of C-sections performed per obstetrician at Level 3 - - facility No of Ophthalmologists performing Cataract Surgeries out of 2 2 Total available Number of cataract surgeries performed per ophthalmologist 19 19 Percentage of deliveries performed by SBA trained 7 8 personnel’s {[( deliveries performed by SBA trained personals / total number of deliveries]*100} Number of deliveries performed per SBA 13 35 No. of LSAS trained personnel providing services 7 7 No. of Emoc trained personnel providing services 7 7 Average number of outpatient cases seen by the mobile 909 909 medical unit (MMU)

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

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the visit) Activity / Measurable Target 2010- Visit in Visit in Visit in Visit in 2011 Q I Q II Q III Q IV indicator Number of ANMs trained as 120 20 40 40 20 SBAs Percentage of ANMs trained 30 5 10 10 5 as SBAs(SBA trained ANMs/Total Number of ANM*100) Number of Doctors trained on 20 5 5 5 5 EmoC Number of Doctors trained on 0 0 0 0 0 LSAS Number of Doctors trained in 0 0 0 0 0 NSV/ Conventional vasectomy Number of Doctors trained in 0 0 0 0 0 Abdominal Tubectomy (Minilap) Number of Doctors trained in 0 0 0 0 0 Laproscopic Tubectomy Number of Personnel trained 1000 250 250 250 250 in IMNCI Number of ASHAs 1493 273 273 273 274 completed four modules of training

Financial Indicators Number of facilities with less than 50% utilization of the untied grants (BPHC 113 and above) Percentage of JSY payments pending as on day of visit (with regards to 0 institutional deliveries in the public facilities only)

Indicators* Activity / Measurable indicator Target 2010- Achievement Achievement 2011 from April from April 2010 till 2010 till Month Month previous to previous to the Month of the Month Visit (in of Visit (in

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numbers) %) Deliveries 77000 10. Total Reported 77000 10555 10555 d. Institutional 61600 9555 9555 e. Home SBA NA - - f. Home Non SBA NA - - 11. Percentage of C- sections performed NA - - (w.r.t institutional deliveries): {[(no. of C section performed/ institutional deliveries)]*100)} 12. Percentage of C- sections performed - - (w.r.t. expected deliveries: {[(no. of - C section performed / expected deliveries)]*100)} 13. Percentage of maternal complication NA - - (medical and surgical)treated against total institutional deliveries {[( maternal complication treated / institutional deliveries)]*100)} 14. Percentage of maternal complication - - - (medical and surgical) treated (w.r.t. expected deliveries): {[(no. of maternal complication treated / expected deliveries)]*100)} 15. High risk pregnancies identified - - - {[(no. of high risk pregnancies sidentified / No. Of ANC registered)]*100)} Family Planning 1. Male sterilisation (in numbers) 17000 685 685 2. Female Sterilization 542 08 08 3. No. of IUD insertion 15722 2057 2057 No. Of Facilities providing safe abortion 08 08 08 services Disease control Case Detection Rate of TB among new 0.53% 0.53% 0.53% sputum positive patients Treatment Success Rate among new sputum 86% 86% 86% positive patients initiated on DOTS ABER for Malaria 4.91 4.91 4.91 API for Malaria 0.04 0.04 0.04 Annual New Case Detection Rate for 10.41 10.41 10.41 Leprosy

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Cataract Surgeries performed in the District 11175 2230 2230 No. of Reconstructive surgeries performed - - - under NLEP *In last 3 months according to the VHND microplan (check the Sub Centre Register)

Other Indicators (previous month data) Percent of data elements uploaded 50% Percentage of functional/ working ILR points8 {[number of functional ILR points]/ [number of total ILR points]}*100

-Service Delivery (For previous month) Percentage of Medical camps conducted against planned {[medical camps 0 conducted/medical camps planned]*100} Percent of VHNDs conducted against planned* 5392

Functional Mobile Medical Units (MMU)9 1

8 ILR : ice line refrigerator 9 Analyze as per state policy

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

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

Sub Centre

No. Infrastru Electrici Essentia Stay Equipments Conduct New Comm cture ty and l Drugs facility for ing Born ent water for the conducting deliveri Baby ANM delivery and es Corner newborn resuscitation 396 297 45 396 297 297 15 15 0

PHC, BPHC and CHC

Names Infrastr Beds in 24X7 Essential Stay Conduc Stabiliz Comm ucture hospital SBA Drugs facility ting ation ent BPHC: 6 availabl and for the deliveri Unit CHC: 30 e Equipme doctor es nts and staff Sewar PHC Bansi PHC Behnera PHC Chiksana PHC Kumher Rarah Ajan PHC Dehra PHC Paprera PHC Dhanwara PHC Astawan PHC Abar PHC Pengore PHC Bhatawali PHC SAWAORA PHC NADBAI CHC

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HANTRA PHC PEHERSAL PHC BALORI CHHAR PHC LAKHANPUR PHC DEEG CHC PUNCHARI CHC KORER PHC BAHAJ PHC PHC JANUTHAR PHC KHO PHC KAMAN CHC JURHERA PHC GHATA PHC SOMKA PHC BILOND PHC NONERA PHC NAGAR CHC SIKRI CHC SUNDRAWALI PHC MUDIA PHC GOPALGARH PHC PAHADI PHC RAUGH PHC MANOTA KALAN PHC BARKERA PHC BAYANA CHC SINGHADA PHC BRAHAMBAD PHC JHEELKABADA PHC KHDLIGADASIA PHC BANDHABARETH A PHC KALSADA PHC ROOPWAS CHC UCHHAIN CHC RUDAWAL PHC BANSIPAHADPUR

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PHC KHANUA PHC JATMASI PHC BHUSAWAR CHC WEIR CHC BIJWARI PHC DHARSONI PHC JEEVAD PHC RANDHIGARH PHC BACHHRAIN PHC SARSENA PHC LALITAMUDA PHC ALIPUR PHC SALEMPUR PHC NITHAR PHC HALENA PHC BALLABHGARH PHC PATHENA PHC

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SUB PLAN FOR DISTRICT- BHARATPUR (RAJASTHAN) A. Total Population : 2626427 CBR : 27.5 B. Expected Deliveries per year : : 77930 ( calculated from above) C. Total reported deliveries ( from HMIS) : in nos and as % of expected deliveries : 9559 D. Actual Delivery ( from HMIS verified at dt & block) as numbers and as % of expected deliveries: 9559 (Ins) +1639( home) : Home SBA 1602 Home Non SBA 37 E. Total Unreported deliveries : B-C as a % of B and in numbers

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SUB PLAN: ______district name_BHARATPUR_ (____Rajasthan___)

Deliveries Facility operationalisation 2009-10 2010-11 2011-12 2009-10 2010-11 2011-12 Level 1 facility Total nos. Of deliveries 31972 2023 Normal - - - Total- Total- Total- Level 2 facility Total no. of deliveries 766 4646 Normal Others complicated Total- Total- Total- Level 3 facility Total nos. of deliveries 2629 1728 Normal C-sections Other complicated / Total- Total- Total- expected complications

HR Planning Current level Target Existing HR Additional Training Supportive Budget HR load supervision required Level 1 facility (PHCs and SCs)

Level 2 facility

Total- Total- Level -3 facility

Total- Total- Infrastructure Planning

Existing Additional Provision Newborn Infrastructure Referral beds beds to for Blood Corners/ & Equipment transport be added banks / Neonatal required Blood Stabilisation Storage Units/ SNCUs Units needed Level 1 06 - No facility

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Level 2 30 Yes Yes Yes facility

Level 3 150 Yes No No facility

Current Level Aims to Reach Home Based Newborn and Sick Child Care Ordinary Skilled & ANM Skills in Child care Line Listing of Pregnant Women and Children below 2 Facilitation for ASHA’s/ Mothers at Facility NGO Involvement Other activities (pls specify)

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