1. District Banka
Major observations of Field Survey Unit, Patna about the Evaluation work in Banka District of Bihar State in May 2010.
I. Details of the visited Institutions: District Visited RH/PHC visited HSCs visited
Banka Referral Hospital, Bounsi Lilavaran, Shyam Bazar and Bagdumba PHC- Barahat
II.Major Observations:
1. Implementation of Rogi Kalyan Samiti (RKS) and Village Health & Sanitation
Committee (VHSC):
i. RKS has been constituted in 11 institutes i.e. 3 RH, 7 PHC and in Sadar Hospital in the district.
ii. RKSs were found to be constituted at visited health care institutions and the meetings
of RKS at PHC Barahat was being conducted regularly but in RH Bounsi, meetings
were not being held regularly.
iii. It was reported that 184 VHSC were functioning in the district and most of the
VHSCs were operating joint bank account for handling the funds.
2. Service of ASHA:
i. Out of requirement of 1820 ASHAs in the district 1672 ASHAs were in position, 172
ASHAs were reported to have been provided with 4 Modules of Training.
ii. Drug Kits were provided to 1552 ASHAs out of 1672 ASHAs in the district.
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iii. In the selected PHCs at Barahat and RH Bounsi, it was found that most of the ASHAs
were trained only in 1st Module.
3. Untied Funds:
i. During visit to PHC and Sub-centers, it was noticed that untied funds were provided
to these centres during 2009-10 in the district.
ii. Referral Hospital at Bounsi did not receive funds in 2009-10. Funds allotted in 2008-
09 were utilized by the centre during 2009-10 only.
iii. During 2010-11, no untied fund was provided to the visited institutions in the district
till the month of visit.
4. Functioning of Janani Suraksha Yojna (JSY):
i. JSY beneficiaries were being benefited under JSY at the visited institutions and
number of institutional deliveries were increasing in the district.
ii. Provision of funds under JSY:
Sr.No. Particulars Year 2008-09 2009-10
1. Total number of deliveries eligible for 25,147 24,235 payment under JSY
2. Total number of beneficiaries to whom 25,147 24,235 JSY fund paid.
3. Total Fund available including opening 5,06,77,300 5,06,67,200 balance
4. Expenditure incurred under JSY 4,70,03,800 4,70,14,200
5. Balance Amount 36,73,500 36,53,000
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ii. An amount to the tune of Rs.35,73, 900 was incurred out of the allotted funds of Rs.
36,07,400 in 2009-10 in PHC Barahat and JSY incentive was provided to 2,019
beneficial. 2420 JSY mothers were benefited at RH Bounsi and an expenditure to
the tune of Rs.45, 53,000 was incurred out of Rs. 46,32,900 provided to the centre
during 2009-10.
iii. During physical sample verification, 13 JSY beneficiaries in the area of the visited
centres, were contacted and it was found that MCH Cards were not properly filled
ANC/PNC services provided to the mother were not satisfactory.
iv. Transport and cash assistants payments were received by all contacted beneficiaries.
5. 24X7 hours services:
i. 24x7 services for promotion of institutional deliveries were available at the visited
health centres in the district.
ii. Infrastructure and staff like specialists and staff nurses etc. for caring mothers & new
born babies were found inadequate in the visited PHCs.
6. Physical Infrastructure:
There are 2 CHCs, one Sadar Hospital, 11 PHCs and 2651 HSCs in the district. Out
of that Sadar Hospital, 2 CHCs, 11 PHCs and 48 HSCs were having Govt.
accommodation and 217 sub centre centres were functioning in private building.
(i) RH/PHC
i. RH Bounsi and PHC Barahat were functioning in Government building and
electricity, water, Toilet and Labour room etc. were available there.
ii. AYUSH Medical Officer was not posted in these visited Institutions.
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iii. Except Vitamin ‘A’ tablets, all the Prophylactic Drugs were available at RH Bounsi
and PHC Barahat. Vitamin- ‘A’ tablets were not available at PHC Barahat on the day
of visit.
(ii) HSC:
i. The visited HSCs Lilavaran and Bagdumba were functioning in rented
building whereas HSC Shyam Bazar was functioning in Govt. building.
ANM was not staying in HSC head quarter.
ii. Hand Pump was the main sources of drinking water in HSCs Lilavaran and
Bagdumba while in HSC Shyam Vazar drinking water facility was not
available.
iii. Toilet and Labour Room was not found in any visited HSC.
iv. Furniture like Foot Stool, Delivery Table, Mcintsh sheets, Ambu bag/Suction
were not available in the visited HSCs.
v. Equipments and drugs like Thermometer, DDKs, Emergency Contraceptive
Pills, Oxytocin Tablets, Cap. Ampicillin, Gentamycin Injection were not
available in the visited HSCs.
7. Knowledge and opinions of community on Health services:
i. The team interviewed 9 mothers in the area of visited sub centres to assess
their knowledge and opinion about the health services being rendered by the
ANMs and found that all contacted mothers were not satisfied with the
availability of the ANMs at the facilities at the time of need.
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ii. As responded, mothers were not much satisfied with the services of
immunization, breast feeding practices, ANC/PNC check up etc. Awareness
among the mothers in respect of danger sign of ARI, use of ORS and
contraceptives etc. was very poor.
iii. In the visited areas of the PHCs, the RCH beneficiaries were satisfied and the
local villagers were also satisfied with the services at PHC headquarters.
iv. It was observed that the MOs were not giving adequate time at PHC and also
their regular visit at remote area was not up to the mark.
8. Maintenance of Records/ Registers:
i. Eligible Couple Register was not maintained at the visited centres. Eligible
Couple Survey Register is the part and parcel record of Family Welfare and
RCH Services, which has been neglected at sub centres level since very long
period. Incharge of the HSCs i.e. ANMs are not conducting eligible couple
survey in their respective areas since more than 5 years. It requires special
attention to conduct the survey on regular basis.
ii. The Sterilization Register was not maintained properly in PHC Barahat.
iii. Registers for family welfare services, like IUD Service Register, Oral Pills
Service Register, CC register, ANC/PNC, and Child Immunization register,
were not maintained properly in any of the visited institutions.
iv. Cases cards for sterilization operations were also not issued to the performing
centers.
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2) District Bhagalpur
Major observations of Field Survey Unit, Patna about the Evaluation work in Bhagalpur, Districts of Bihar States in November, 2010.
I. Details of the visited Institutions:
Districts RH/PHC visited HSCs visited Visited
Bhagalpur Referral Hospital, Sultanganj Dohardin, Kodanda, English, Chechraon and Akbar Nagar PHC- Shahkund
II. Major Observations:
1. Health Human Resources:
As reported, 27 of the 74 sanctioned posts of MO, 5 of the 18 posts of A grade Nurses, 43 of the 397 posts of ANMs, 40 out of the sanctioned posts of 54 Lady Health Visitor and 19 of the 59 sanctioned posts of Basic Health Worker were lying vacant in the district.
2. Implementation of Rogi Kalyan Samiti (RKS) and Village Health & Sanitation Committee (VHSC):
6 of 10 a) In Shahkund PHC the registration of RKS was under process whereas in Referral Hosp. Sultanganj, RKS has been registered but the regular meeting was not being conducted there.
b) There are 1536 Villages in the Districts and only 239 Villages were having Health & Sanitation Committee (VHSC). In the visited Health Sub-Centres, ASHA found to be member of the committee.
3. Service of ASHA : a) Out of requirement of 2311 ASHAs in the district, 2135 ASHAs were in position and all 1536 villages in the district taken up for ASHA intervention. b) Drug kits were provided to 1971 ASHAs and 1795 ASHAs trained in all modules in the districts. c) In the visited PHC at Shahkund, 150 ASHAs were trained up to 5th modules out of 176 ASHA in position and in Ref. Hosp. Sultanganj out of 186 ASHA in position, 159 ASHAs were trained up to 3rd module.
4. Untied Funds: a) In the visited PHC at Sahkund, @ Rs. 25,000 have been provided as Untied fund during2009-10 and 2010-11 and also utilized the fund fully in 2009-10. b) Similarly, in Referral Hospital at Sultanganj Rs. 2, 10,000 in the financial year 2009- 10 and Rs. 2,35,000 during 2010-11 were provided under this head and the funds utilized to the tune of Rs. 98,157 in 2009-10. c) No expenditure has been incurred during 2010-11 in the visited institutions till the time of visit. 5. Functioning of Janani Suraksha Yojna (JSY):
a) Performance and budget provision under Janani Suraksha Yojana at the visited Health Institutions viz PHC Shahkund & Ref. Hosp. Sultanganj has been reported as under.
Sr. PARCULARS PHC SHAHKUND RH SULTANGANJ No. Last year Current Last year Current Year Year
1. Number of deliveries 3,210 1,769 - - eligible for payment under JSY
2. Number of beneficiaries to 3,210 663 4,387 1,367 whom JSY fund paid
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3. Total fund received 76,69,810 25,00,000 81,93,340 72,08,500
4. Expenditure incurred 64,18,700 13,26,300 80,91,600 24,85,200 under JSY
5. Balance amount 1,35,250 1,44,595 10,1,740 47,23,300
b) In the visited institutions, the payment registers of JSY were being maintained without recording the requisite details. c) 16 (57%) beneficiaries out of the selected 28 could be contacted in the field for verification and as responded they were mostly satisfied with the services and cash assistance received by them under the scheme.
6. 24×7 hours services:
24×7 hour services were available at the visited institutions but requisite equipments for caring mothers & new born babies and also blood storage unit were not there.
7. Physical Infrastructure:
(i) HSCs:-
a) HSCs visited at Dohardih, Kodanda, English Chechraon were having Govt. accommodation and HSC at Akbar Nagar was functioning in related building.
b) Most of the furniture and essential equipments were available except Delivery table, Mcintsh shit and Ambu bag /suction in these centres. c) Other supplies and drugs position was found satisfactory though drugs like EC pills, Oxitocin tab., Cap Ampicilin and injection Gentamycin etc. were not in supply there.
(II) PHC Shahkund:-
a) PHC Shahkund was functioning in Govt. Building having electricity and telephone. However Toilet facility for the patient/staff was in poor condition.
b) The PHC has its own source of drinking water i.e. tube well. Labour room and residential quarters for the medical officers were available but not in good condition.
8 of 10 c) Prophylactic drugs IFA (Large, Small) Tab/ Syrup and Vitamin ‘A’ tablets were not available in the PHC.
(iii) Ref. Hosp. Sultanganj:-
a) The Ref. Hosp. Sultanganj was functioning in Govt. Building.
b) Blood storage unit, examination table, resuscitation equipment and neonatal resuscitation equipment were not available in the hospital.
8. Knowledge & opinions of community on Health services:
a) The respondents interviewed in the visited area in the district were mostly satisfied with the services received from the centres. MCH beneficiaries, Health Workers and villagers expressed their satisfaction towards the PHC level services. They opined for improvement in field visits and also regular stay of MOs in PHCs head quarter.
9. Maintenance of Records/Registers: a) Eligible Couple Survey Registered was not being maintained since last 5 years in the visited PHC Shahkund and Ref. Hosp. Sultanganj.
b) Registers for F.P. services were not being maintained properly at the centers visited.
c) Printed MCH Registers (ANC Register, PNC Register and Child Immunization Register) were provided but they were not being maintained with the required information mostly.
d) Sterilization case cards were not issued to the performing units.
10. Sample Verification of Family Welfare.
a) Sample of Sterilization acceptors could not be selected at PHC Shahkund due to non availability of service register.
b) Totally, 31 F.W. acceptors were selected and 18 acceptors could be contacted during sample verification in the district. It was found that in all the 18 contacted cases, age of spouse was not recorded correctly.
9 of 10 c) 16 beneficiaries for immunization were contacted for sample verification. All the beneficiaries confirmed with the doses and no complication was reported among the beneficiaries due to vaccination.
11. Other Observations: a) Regular supervision at all levels needed to be improved.
b) 24×7 hours services are there in almost all PHCs/Ref. Hosp. in the district but specialists were not posted. c) AYUSH MO has not been posted at the PHCs/Ref. Hosp. in the district.
3). Purnea District
Major observations of Field Survey Unit, Patna about the Evaluation work in Purnea District of Bihar States in December 2010 .
I. Details of the visited Institutions:
Districts RH/PHC visited HSCs visited Visited
Purnea PHCs- Dagarwa and Mahalwari, Ichalo, Jageli and Khuti Srinagar Saheli
II. Major Observations:
Human resources:
10 of 10 a) District level programme officers posts like Addl. Chief Medical Officer, District immunization Officer, District Malaria Officer, District Leprosy Officer were lying vacant.
b) In the Sadar Hospital, 11 posts out of sanctioned strength of 36 posts of Specialist / MO were lying vacant. c) It was reported that there were many technical and non-technical posts lying vacant in the districts. The key posts like 80 of the 359 sanctioned posts of Auxiliary Nurse Midwife, 38 of the 60 sanctioned posts of Lady Health Visitor, 32 of the 33 sanctioned posts of Health Worker, 18 of the 33 sanctioned posts of FWW, 30 of the 60 sanctioned posts of Basic Health Worker and 39 of the 44 sanctioned posts of Pharmacist were vacant in the district.
2. Rogi Kalyan Samiti:
Rogi kalyan Samiti (called as Hospital Management Society in the state) have been formed in Sadar Hospital, Purnia, 3 Referral Hospitals and 11 PHCs in the district.
3. Services of ASHA Scheme:
a) It has been observed that this scheme was functioning well in the district and ASHAs involved in MCH care activities as per NRHM implementation.
b) All 1290 villages had been covered under the scheme in the district and there were 2220 ASHAs in position against the requirement of 2723. c) It has been reported that all 2220 ASHAs were trained in1st module and also provided with drug kits.
d) 155 ASHAs out of 202 in position in PHC Dagarua and 94 ASHAs out of 95 in position in PHC Srinagar had been trained 1st module but drug kits were not provided to them.
4. Utilization of Untied Fund:
a) Both the PHCs visited in the district had provided @ Rs. 25000 as untied fund in last year and utilized the amount.
b) Both the PHCs and Sub-centres visited by the team have not received untied funds during current financial year.
11 of 10 c) It was reported that the district had received untied funds to the tune of Rs. 9, 50,000 in last year and the same amount in current and the expenditure incurred to the tune of Rs. 6,02,136 and Rs.1,05,450 respectively during 2009-10 and 2010-11.
5. Functioning of Janani Suraksha Yojana (JSY): a) Performance and budget provision under Janani Surakasha Yojna at the visiting PHCs in the district as has been reported as under:-
S. Particulars Dagarua PHC Srinagar PHC No. Last Year Current Year Last Current (up to Oct, Year Year 2010)
1. No. of delivery eligible 3,873 3,054 2,476 1,987 for payment under JSY
2. No. of beneficiaries to 3,873 3,054 2,476 1,487 whom JSY fund paid
3. Total fund received 99,00,000 60,28,000 51,50,000 33,00,000
4. Expenditure incurred 78,32,000 53,28,103 51,49,769 21,99,500 under JSY
b) The team contacted 41 JSY beneficiaries in the field and as informed they got the JSY amount, ANC check up, TT injection and also consumed IFA Tab.
6. Physical Infrastructure:
(i) HSCs
a) The team visited HSCs at Mahalwari, Ichalo, Jageli and Khunti Saheli. Only one SC Ichalo was functioning in Govt. Building.
b) Equipments like Benches for Clients, IUD insertion Kit, BP Apparatus were available in Ichalo. Similarly equipment and drugs mostly were available in Jageli, the SC was functioning in library of the village. Supply of printed materials like Eligible couple Registers for family planning services, Stock Register, formats for monthly reporting, Cash Book of untied fund, JSY registration cards were not available.
12 of 10 c) The team tried to verify tour programme / tour diary of the concerned ANM at Jageli, but the tour programme as well as tour diary was not available with the concerned ANM.
d) SBA training to the ANM at Mahalwari and Ichalo has not been provided. e) Labour room facility was not available at Mahalwari.
(ii) PHCs
a) PHCs visited at Dagarua and Shrinagar have own building and facility for regular Water supply, Electricity, Telephone and Toilets for patients/staff was available there.
b) Most of the equipment and drugs were available in both the PHCs. c) However short supply of Oral Pills and Vitamin ‘A’ tablets, IFA Tablet and Measles vaccines was fobserved in PHC Shrinagar. d) During visit to the PHCs at Dagarua and Srinagar, it was observed that the labour room in both PHCs were not neat and clean.
7. Reconciliation of Sterilization report:
a. During cross check, it was observed that the sterilizations (NSV and Tubectomy) reported by district office for 2009-10 for PHCs Dagarua and Srinagar did not tally with the corresponding figures reported at PHC head quarters.
b. There was no NSV performance in PHC Dagarua in 2009-10 but district office reported 7 NSVs against this PHC for the same year. Similarly, district office reported 1108 tubectomy operations against total tubectomy of 1099 in PHC Dagarua for 2009-10. c. There was no tubectomy & NSV case reported by PHC Srinagar in 2009-10 but district report says 6 NSV cases conducted by the PHC for the same year. Similarly NSVs in the Srinagar PHC were reported to be as 14 during 2010-11 but district office showed it as nil.
8. Maintenance of Records & Registers:
a) Eligible couple survey has not been conducted since long in the visited centres.
13 of 10 b) IUD register was not maintained properly at PHC Srinagar and the same was not made available at PHC Dagarua. c) Maintenance of MCH registers (ANC, PNC and immunization) need improvement.
d) Stock register for FP and MCH items were not properly maintained at Dagarua & Srinagar PHCs. e) Condom, OP and PNC records were not made available to the team for verification at some of the Centres.
4. Araria District
Major observations of Field Survey Unit, Patna about the Evaluation work in Areria Districts of Bihar States in January 2011 respectively.
I. Details of the visited Institutions:
Districts RH/PHC visited HSCs visited Visited
Araria PHCs Narpatganj and Palasi Sonapur, Ghuna Fulkaha, Urlaha Pakri, Balundyarohi and Kaliagnaj
II. Major Observations:
1. Health Human Resources:-
(a) The district was facing hardship in providing effective health care delivery to the people due to vacancies of DMO, DIO, M & E Officer, Medical Officer (Lepro) and 3 of 9 posts of BHM .
(b) Large number of vacancy in the medical and para medical category of the posts was reported. 64 of the 121 sanctioned post of MO, 35 of the sanctioned posst of 39 ‘A” grade nurses, 37 of the 45 sanctioned post of LHV, 113 of the 274 sanctioned posts of ANM, 43 of the 46 sanctioned post of Pharmacist, 17 of the 30 sanctioned post of Health Educators and 32 of the 37 sanctioned posts of lab Technician were lying vacant.
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(c) Similarly more than 50% of the sanctioned posts of class III staff who are skilled workers at the Periphery level were also lying vacant in the district.
(d) 23 posts of Contractual Doctors (Allopathy) against required 36, 3 posts of MO (AYUSH) against required 32 and 18 posts of A grade nurses against 96 required in the district were vacant.
2. Rogi Kalyan Samiti (RKS) and village Health & sanitation Committee (VHSC):
a. RKS has been constituted in Sadar Hospital, 3 RHS and 6 PHCs in the district, and regular meeting in the visited PHCs was being conducted.
b. Out of 781 villages in the Distt, Health and Sanitation Committee (VH &SC) were functioning in 218 villages. In the visited health sub Centres, ASHA was a member of VHSC.
3. Services of ASHA:
(a) As per the details available from district and the PHCs, ASHAs scheme was functioning well and also the beneficiaries were happy. All 781 villages are covered under the scheme and as many as 2306 ASHAs were trained in 1st module against the requirement of 2376 were in position in the district. It was reported that 2026 ASHA’s have been trained in Ist Module.
(b) During visit, it was informed that there were 308 ASHAs, in PHC Narpatgantj and 188 in PHC Palasi. All reported ASHAs in Narpatganj were trained in Ist Module and only 60 ASHAs were trained to Ist Module in Palasi.
4. Services of Janani Suraksha Yojna (JSY):
(a) The status of implementation of JSY in the district during last two years is given below. Status for the district as a whole is given below
Srl Particulars 2009-10 2010-11 (upto no Nov, 2010)
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1 Total number of deliveries eligible for payment 51531 41949 under JSY
2 Total number of beneficiaries to whom JSY 51531 29860 fund paid
4 Total Funds Received (RCH II Head) 13,63,83,474 11,14,19,668
5 Expenditure incurred under JSY. 98,25,960 59,210,691
(b) In the visited PHCs at Narpatganj & Palasi, the fund under the scheme was sufficient and all the JSY beneficiaries identified for cash assistance during last two years have been provided incentives.
(c) 25 JSY beneficiaries were interviewed in the district and found satisfied with the services and they had received cash assistance under the scheme.
5. 24×7 House Delivery Care System:
a. 24 x 7 Services were provided by Sadar Hospital, 3 RHS and 9 PHCs in the district. b. These services were available at the visited PHCs in the district. There were good number of deliveries reported in the last year and current year. There was also sufficient staff at both the PHCs. No blood storage unit has been setup in the PHCs visited at Narpatganj and Palasi. 6 Utilisation of Untied fund: a Untied funds for PHCs and the sub centre functioning under the PHCs were provided to the PHCs in the district.
b In PHC Narpatganj and its sub Centres, Rs. 4,92,000 including opening balance of Rs. 2,72,000 were available and out of it an expenditure to the tune Rs. 4,32,000 was incurred in the year 2009-10. During 2010-11 no expenditure was reported till the month though sufficient funds were avaliable.
c. For PHC Palasi and its sub centres, untied funds to the tune of Rs. 3,20,000 including 1,60,000 as previous balance were available in the year 2009-10 and spent to the tune of Rs. 2,00,000 in the year. Rs. 2,63,000 were also available during 2010-11 and no expenditure was reported till the visiting month.
9. Physical infrastructure
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(i) PHC
a. PHC Norpatganj was functioning in Govt. building with the facility of electricity and telephone. Drinking Water Facility was available within the campus. Toilet Facility for staff and patient was also available there.
b. PHC Palasi was also functioning in Govt. building and equipped with telephone & electricity. Toilet facility was found available but sanitation was not maintained there. Labor room and wards were visited by the team and found unhealthy for delivered mothers and new born babies.
(ii) HSCs
a HSC Sonapur, Ghuna, Kaiaganj and Fulkaha were functioning in the Govt. building whereas HSCs at Urlaha, Palri and Balundgarohi were functioning in rented building.
b. ANMs of the respective sub-centre were not staying at their head quarters except at HSC Kaliaganj.
c. Almost all visited HSCs were having hand pumps for drinking water but electricity, toilets and labour room facility were not available there. d. Most of the furnitures and equipments were available in the HSCs, However delivery table, MaIntsh sheet, Ambu bag / suction, IUD insertion kit, DDKs and slides etc. were not available at one or other places.
10. Knowledge and opinion of community and Health Services.
Services provided by the ANMs in the areas of HSCs and by the MO, and staff of the visited PHCs were satisfactory as opined by the community members in the visited centres.
9. Maintenance of Records & Registers
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Maintenance of registers and records was generally found satisfactory in the centre visited; however, case cards for sterilization cases were not maintained at the reporting Units.
10. Other observations a. The basic register of eligible couple has not been prepared for long time in all the visited centres in the district. b. Short supply of CU-T, OP, IFA (small), Vitamin “A”, DT and O.P.V. was noticed by the team during visit to the district. c. Regular supervision was lacking at periphery level in the district. d. No residential quarters were available for the PHC staff and PHC MO at PHC Palasi were available. e. Cashbook for united fund, JSY registration cards, printed record for FP Services and E.C. records etc. were not available in the visited centers.
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